Optimising knee osteoarthritis care through collaboration

APOS Health is a clinically validated, non-invasive therapy system for knee osteoarthritis (OA) that uses a personalised foot worn device with calibrated biomechanical elements, alongside a structured gait based exercise programme to reduce joint loading and retrain neuromuscular control. By altering the distribution of forces through the knee during walking and daily activity, APOS therapy can reduce pain, improve function, and enhance gait symmetry while patients continue normal activities at home.

These trusts are now sharing collective learning to help address common challenges associated with adopting new technologies and to support sustainable, whole pathway implementation.

• Wirral University Teaching Hospital NHS Foundation Trust
• Wrightington Wigan & Leigh NHS Foundation Trust (WWL)
• The Rotherham NHS Foundation Trust
• Bradford Teaching Hospitals NHS Foundation Trust
• East Lancashire Hospitals NHS Trust.

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Working in partnership across Orthotics and MSK services, the five trusts are co‑designing and refining pathway approaches, with a shared focus on:

• Improving patient choice
• Expanding access to conservative treatment options
• Supporting better clinical outcomes
• Reducing unwarranted variation across the region.

Our teams at NHS Supply Chain and the regional Health Innovation Network (HINs) are supporting this work by helping trusts address common early‑stage challenges associated with adopting an innovative OA technology, including:

• Variation in referral routes and clinical inclusion criteria
• Unclear service ownership and operational responsibility
• Clinician and patient readiness for change
• Balancing upfront costs with wider pathway savings.

By sharing real‑world learning, the trusts are developing practical, scalable solutions that streamline implementation and support sustainable, region‑wide adoption of APOS Health.

Across all five trusts, common areas of focus have included:

Orthotists, physiotherapists, MSK clinicians, orthopaedic teams, our Care Pathway Team (CPT) and the regional HINs are working in close collaboration to introduce APOS Health consistently and effectively.

• Building shared understanding of where APOS Health sits within local pathways.
• Identifying patient cohorts most likely to benefit, aligned to evidence and NICE guidance.
• Improving awareness of referral processes to support appropriate and timely access.
• Exploring whole pathway cost impact, rather than focusing solely on upfront device costs.

NICE endorsement (HTG671) plays a critical role in accelerating adoption for NHS organisations. For commissioners and providers, the guidance:

• Confirms clinical efficacy through independent assessment.
• Validates adoption for a clearly defined patient cohort.
• Supports business cases focused on whole‑pathway value rather than departmental cost.
• Strengthens assurance at ICB, Trust Board, and GIRFT review level.

Importantly, NICE guidance states that commissioners and providers have a responsibility to implement recommended technologies in a way that reflects local pathways and governance, reinforcing the legitimacy of APOS Health as part of routine NHS care rather than pilot activity.

Common issues highlighted include:

• The need to raise awareness of new treatment options in pathways.
• Issues with generating sufficient appropriate patient referrals which is being addressed by ensuring communication between other departments seeing patients.
• Rising pressure on MSK and orthopaedic services.
• Affordability concerns in respect of implementation and ongoing funding.

APOS Health delivers productivity and efficiency benefits as well as improved patient outcomes over a three-year period:

• The efficiency and productivity (E&P) benefit on a three year cumulative basis is reflecting ongoing capacity release and pathway maturity, rather than reporting it as a one off in year procurement saving.

Expanding equitable access to innovation supports:

• Informed patient choice, aligned with NICE guidance
• Earlier intervention for those at risk of deterioration
• Reduced dependency on invasive or episodic treatments such as steroid injections, physiotherapy, GP visits.

Embedding innovative options consistently across all the region’s pathways, ensures patients are not forced to self‑advocate, travel long distances, or seek private care to access alternatives. This is an important consideration for addressing socioeconomic inequality.

The shared learning from the five trusts, the HINs and the CPT is already delivering positive impact:

• Greater pathway consistency
• Clearer and more confident referral decisions
• Increasing options of conservative management enhancing patient choice
• Increased workforce capability
• A scalable model supporting elective recovery.

This collaborative model allows learning from one service to inform others, reducing duplication of effort and supporting more efficient adoption across the system.

The upfront cost is too high
In practice, trusts have found value is best assessed at pathway level. While costs may sit within one service, benefits are realised across MSK, orthopaedics and wider secondary care.

There’s no budget for it in our service
Shared experience highlights how budget silos can obscure pathway benefit. Collaborative planning helps organisations consider value beyond individual services

Clinicians are unsure
Initial caution is common with new technologies. Where APOS Health is embedded, it complements existing orthotics and physiotherapy services rather than replacing them.

Patients expect bracing, injections or surgery
With clear education, patients engage well in active, gait‑based therapy, particularly when positioned as a way to avoid escalation.

We don’t have capacity to take this on
While setup and training are required, APOS reduces downstream workload by slowing progression and avoiding repeat appointments and referrals.

We need local evidence before adopting
Peer-to-peer learning and comparable NHS experience have been important in building confidence alongside national evidence.

It’s hard to prove the outcomes
Many of the benefits of APOS Health accumulate over time, such as delayed or avoided surgery, reduced imaging, fewer injections, and fewer follow‑ups. Because these gains occur gradually, agreed outcome frameworks are essential to demonstrate medium‑term ROI, rather than relying solely on short‑term activity metrics.

Using NHS and NICE referenced modelling, indicative analysis suggests potential pathway level savings of approximately £4,000–£4,500 per patient over three years, based on an estimated £1,478 annual saving.

These figures are intended to support discussion rather than act as fixed assumptions. Key considerations include:

• Use within the NICE recommended cohort
• Benefits realised at pathway level, not within a single budget
• Value driven primarily by avoided repeat conservative care and delayed surgery
• The importance of locally agreed outcome frameworks to demonstrate impact over time.

Our Care Pathway Team plays a crucial role in enabling trusts to measure, evidence, and sustain the benefits of APOS Health. Support includes:

• Peer‑to‑peer clinician discussions
• Support with Pathway redesign and optimisation linked to Productivity and Efficiency Modelling
• SOP development
• Full cost‑modelling, including whole‑pathway financial impact
• Efficiency and productivity modelling
• Data and evaluation guidance
• Training for orthotists, physiotherapists, and service coordinators.

This approach helps services build confidence and capability, while reducing duplication of effort.

Trusts across the north continue to share experience as APOS Health is embedded, supporting others who may be considering how to strengthen conservative knee OA care.

To explore how shared learning and pathway support could apply locally, services can engage with their Care Pathway Specialist or Clinical Care Pathway Manager to discuss next steps aligned to local needs and priorities.

As APOS Health has been introduced, trusts across the North have openly shared experience to support others, including:

As we are expanding the use of APOS Health, collaboration is playing an important role in helping us understand how best to integrate it within existing MSK and orthotics pathways. Sharing experience across trusts supports consistency, improves confidence and ultimately helps us offer patients greater choice in their care.

Kieran Cunningham, Senior Orthotist, East Lancashire Teaching Hospitals NHS Trust