Improving patient outcomes with knee osteoarthritis


  • 2010: Initial set up in the UK
  • 2020: Clinical trial in Journal of the American Medical Association (JAMA) published
  • May 2021: Joined the NHS Innovation Service
  • June-July 2021: Received responses from NICE, the Health Innovation Network and NHS Supply Chain
  • April 2023: NICE guidance published, recommending the product
  • October 2023: Available via NHS Supply Chain
  • May 2023: Joined the MedTech Funding Mandate

Apos Health is a foot worn medical device that helps people with knee, hip and lower back pain relating to osteoarthritis.

Knee pain relating to osteoarthritis effects 5.4 million of the population and is more prevalent and severe in women. To treat it, NICE recommends exercise, weight management and sometimes walking aids or medication. For milder cases, these treatments are effective, however if symptoms worsen, surgery can be offered.

A knee operation can be painful and invasive and often has residual complications. Co-morbidities and weight restrictions mean that not everyone is suitable for surgery, so having an effective alternative is important.

The device provides an alternative option to surgery where first line treatment has not been effective and it’s use may delay the need for surgery for several years.

Introduced to the UK in 2010, the medical device has two parts mounted on rails that calibrate to patients needs following a gait assessment. The device changes the forces acting on the knee to reduce pain and helps retrain the muscles around the knee to work more efficiently.

Journey to market

By registering the product with the NHS Innovation Service, the company were able to access support from NICE, NHS Supply Chain and the Health Innovation Network.

An independent randomised control trial on the clinical effectiveness of the device was published in the Journal of the American Medical Association (JAMA), a peer-reviewed medical journal. NHS Innovation Service partners provided advice that helped the company collect real world evidence, off the back of this work.

Partners also advised the company to actively involve patients and the public to help refine where and how the product could offer the most value to meet patient needs.


"Talking with our patients, their knee pain prevented them from doing everyday activities, such as shopping or walking the dog. The device is able to give back that quality of life." Sachin Gohil, Apos Health's Chief Commercial Officer

NICE selected the innovation to be assessed under the NICE MedTech Evaluation programme, which resulted in guidance recommending the device as a cost-saving solution for a particular cohort of people. NHS Supply Chain helped direct the company towards finding a distributor, which meant Apos Health could then get on the supply chain.


“The NHS Innovation Service is an essential component in getting new products and services to end users efficiently. It allows NHS Supply Chain to work collaboratively with the innovator in parallel to the other key supporting organisations, allowing innovation to reach the NHS, improving the outcomes for patients, or addressing the challenges faced in the NHS.” Fay Allen, Innovation Specialist at NHS Supply Chain

The device is now recommended by NICE for knee osteoarthritis patients who meet the criteria for joint replacement surgery and who have not responded adequately to the recommended NICE therapies.

The innovation has been selected as part of the MedTech Funding Mandate for national adoption for 2024/25.

The patient perspective

Six years ago, Christine Harpur, from Northern Ireland, struggled with bad knees to the point where she could hardly walk, and knee replacement surgery was recommended. However, Christine was not keen on the idea of surgery. She became aware of the product and after consulting with her physiotherapist decided to give the device a try.

The result has been life changing for her:


“They have saved me from a life of pain, and a life of not being able to do the things I want to do. Apos Health has given me back the freedom to do what I want with less pain.”

Key takeaways