Insights help with adoption of nonsurgical device for knee patients

Patient insights have helped to inform the adoption of a device which provides a non-surgical option for patients with knee osteoarthritis at The Rotherham NHS Foundation Trust.

Adoption of Apos aligned with NICE guidance and the MedTech Funding Mandate and showed how non-surgical options can be embedded within existing orthotics services to improve pain, function, and confidence for patients.

Our role was conducting a patient insight activity exploring experience of knee osteoarthritis and decision-making within the total knee replacement pathway, between December 2024 and January 2025.

All 23 Rotherham patients with severe osteoarthritis who used Apos between 2024 and 2026, reported improvements.

Cost savings in the first year, based on NICE cost modelling projections, were calculated at £40,500, through avoided surgeries and reduced use of existing therapies.

The challenge

Musculoskeletal conditions, particularly knee osteoarthritis, place a significant and growing burden on individuals and the NHS. Many patients describe chronic pain, reduced mobility, and loss of independence that affect their ability to work, care for family, and maintain mental wellbeing.

Across Yorkshire and the Humber, ageing populations and health inequalities intensify these pressures. Patients frequently report a perceived gap in care between physiotherapy and surgery, with limited non-surgical options available once core treatments have been exhausted.

Feedback from patients in Rotherham reflected this wider picture. Individuals described long-term pain, frustration with limited treatment choices, and a desire for options that could help them remain active while delaying or avoiding surgery where possible. This context created both a clinical and patient-driven rationale to explore alternative approaches within the MSK pathway.

Why Apos?

In April 2023, a personalised footwear device from AposHealth was recommended by the National Institute of Care Excellence (NICE) as a cost-saving, non-surgical treatment option for adults with knee osteoarthritis whose symptoms persist despite standard care.  The guideline recommends its adoption for patients who meet the referral criteria for total knee replacement but wish to delay or avoid surgery.

It was subsequently selected by NHS England for support through the MedTech Funding Mandate to enable widespread adoption and spread within the NHS.

For The Rotherham NHS Foundation Trust, this aligned with a wider ambition to strengthen conservative management and provide meaningful patient choice within the MSK pathway.

Rotherham has been offering Apos since August 2024 and by April 2026, 23 patients were using the therapy.

Early barrier: Referral origin and funding

Early implementation was constrained by referral routes, with access initially limited to GP-referred patients. This restricted early uptake.

Increasing awareness across the trust

Targeted training delivered to orthopaedic therapy teams, orthopaedic consultants, and MSK physiotherapists significantly improved awareness and understanding of Apos.

As a result:

• Referrals increasingly began to reference Apos directly
• Access expanded beyond the original GP-only pathway
• Secondary care colleagues became engaged in conservative management discussions

Integrating into clinical processes

Rotherham has embedded Apos into routine orthotics workflow rather than operating a dedicated clinic day.

To support structured monitoring and improve efficiency, the team has:

• Begun sending the Apos short-form questionnaire alongside initial appointment letters for patients who may be eligible based on referral information
• Introduced a Microsoft Forms follow-up questionnaire sent via SMS approximately one week before telephone reviews
• Used gait analysis data collected via the Apos app to monitor measurable physical improvements over time

This approach enables systematic follow-up, supports clinical decision-making, and provides patients with visible evidence of progress. It also helps streamline appointments and strengthens routine outcome data collection.

Insights from patients

Between December 2024 and January 2025, Health Innovation Yorkshire & Humber conducted a patient insight activity exploring experience of knee osteoarthritis and decision-making within the total knee replacement pathway.

As part of this work, the Rotherham Orthotics Team supported access to two patients who were existing Apos users. This enabled in-depth exploration of patient journeys before and after Apos was introduced.

These interviews highlighted:

• The perceived lack of options between physiotherapy and surgery
• The importance of treatments that fit into daily life
• The value patients place on regaining control and confidence

Insight from Rotherham patients helped shape Health Innovation Yorkshire & Humber’s wider patient insight framework and reinforced the potential role of Apos as a meaningful ‘in-between’ intervention within the MSK pathway.

Feedback highlighted:

• Reduced pain
• Improved mobility and posture
• Increased confidence in walking and daily activities
• Positive impacts on mental wellbeing and independence

Feedback from clinicians

Sacha Bergmann, Orthotist at The Rotherham NHS Foundation Trust, said:

“Since introducing Apos into our orthotic service last year, we’ve seen great improvements in our patients’ mobility and quality of life. Patients complete questionnaires and their gait is analysed via an app at review appointments, allowing us to see not only biomechanical improvements but also impacts on daily living. One patient who previously struggled with pain and limited movement is now able to play with their grandchildren pain-free.”

Helen Frederick, Clinical Lead Orthotist at The Rotherham NHS Foundation Trust, said:

“Initially we focused on GP referrals, but we are now extending this to secondary care colleagues within the Trust. Apos has become an important additional option for the conservative management of knee osteoarthritis.”

Ongoing considerations

While early experience at Rotherham has been positive, continued focus is required to:

• Maintain awareness among clinicians and referrers
• Ensure consistent referral criteria
• Align funding and commissioning routes to support equitable access

Rotherham is actively addressing these areas through education, pathway refinement, and ongoing evaluation of patient outcomes.

Next steps

The next stage is to build on this learning and continue widening access so that more patients, particularly those in communities disproportionately affected by musculoskeletal conditions, can benefit from timely, non-surgical options within the MSK pathway.

 

Wayne’s story

Wayne Booth, 56 from South Yorkshire, was forced to stop work as a granite fitter due to ‘shocking pain’ from osteoarthritis in both knees.

“I saw a physio at the hospital who offered me either a brace which would require me to make weekly visits to have it adjusted, or these new shoes with rubber pods on the soles.

“The physio had an app on her phone which I put in my pocket and walked up and down the corridor; this allowed her to get measurements which she used to adjust the pods on the soles.

“At first, I wore them for five minutes a day around the house, building up gradually to half an hour. From day one I could feel the difference; it was painful, but I could feel the muscles in my legs working differently, drawing my knees in.

“It felt like I had been to the gym, I could feel my muscles strengthening.

“The shoes are very comfy, just like wearing slippers!  Before using these shoes, I had to go up the stairs on all fours, I’m still in pain but now I can walk up in an upright position slowly using the banister.

“I used to walk stiffed legged, but I now can bend my legs a little more, this has slightly improved my quality of life for the better. I can now go for slow short walks on the street with my grandson. I can help a little more around the house doing light chores at a slow pace. I must take my time as I still get pain but not as intense as it used to be.

“Overall, I feel my mood has lifted a little. I’m not ready to part with my knees just yet, and these shoes are helping me to avoid having replacements for the time being.

“I would recommend anyone in my position to give these shoes a go.”