Effect of variable-stiffness walking shoes on knee adduction moment, pain, and function in subjects with medial compartment knee osteoarthritis after 1 year

This study investigated the load‐modifying and clinical efficacy of variable‐stiffness shoes after 12 months in subjects with medial compartment knee osteoarthritis. Subjects who completed a prior 6‐month study were asked to wear their assigned constant‐stiffness control or variable‐stiffness intervention shoes during the remainder of the study. Changes in peak knee adduction moment, total Western Ontario and McMaster Universities (WOMAC), and WOMAC pain scores were assessed. Seventy‐nine subjects were enrolled, and 55 completed the trial. Using an intention‐to‐treat analysis, the variable‐stiffness shoes reduced the within‐day peak knee adduction moment (?5.5%, p < 0.001) in the intervention subjects, while the constant‐stiffness shoes increased the peak knee adduction moment in the control subjects (+3.1%, p = 0.015) at the 12‐month visit. WOMAC pain and total scores for the intervention group were significantly reduced from baseline to 12 months (?32%, p = 0.002 and ?35%, p = 0.007, respectively). The control group had a reduction of 27% in WOMAC pain score (p = 0.04) and no significant reduction in total WOMAC score. Reductions in WOMAC pain and total scores were similar between groups (p = 0.8 and p = 0.47, respectively). In the intervention group, reductions in adduction moment were related to improvements in pain and function (R² = 0.11, p = 0.04). Analysis by disease severity revealed greater efficacy in adduction moment reduction in the less severe intervention group. While the long‐term effects of the intervention shoes on pain and function did not differ from control, the data suggest wearing the intervention shoe reduces the within‐day adduction moment after long‐term wear, and thus should reduce loading on the affected medial compartment of the knee. © 2011 Orthopaedic Research Society. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:514–521, 2012     

Changes in in vivo knee loading with a variable‐stiffness intervention shoe correlate with changes in the knee adduction moment

External knee adduction moment can be reduced using footwear interventions, but the exact changes in in vivo medial joint loading remain unknown. An instrumented knee replacement was used to assess changes in in vivo medial joint loading in a single patient walking with a variable‐stiffness intervention shoe. We hypothesized that during walking with a load modifying variable‐stiffness shoe intervention: (1) the first peak knee adduction moment will be reduced compared to a subject's personal shoes; (2) the first peak in vivo medial contact force will be reduced compared to personal shoes; and (3) the reduction in knee adduction moment will be correlated with the reduction in medial contact force. The instrumentation included a motion capture system, force plate, and the instrumented knee prosthesis. The intervention shoe reduced the first peak knee adduction moment (13.3%, p = 0.011) and medial compartment joint contact force (12.3%; p = 0.008) compared to the personal shoe. The change in first peak knee adduction moment was significantly correlated with the change in first peak medial contact force (R² = 0.67, p = 0.007). Thus, for a single subject with a total knee prosthesis the variable‐stiffness shoe reduces loading on the affected compartment of the joint. The reductions in the external knee adduction moment are indicative of reductions in in vivo medial compressive force with this intervention. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1548–1553, 2010     

In healthy subjects without knee osteoarthritis, the peak knee adduction moment influences the acute effect of shoe interventions designed to reduce medial compartment knee load.

The purpose of this study was to evaluate shoe sole material stiffness changes and angle changes that are intended to reduce the peak knee adduction moment during walking. Fourteen physically active adults were tested wearing their personal shoes (control) and five intervention pairs, two with stiffness variations, two with angle variations, and a placebo shoe. The intervention shoes were evaluated based on how much they reduced the peak knee adduction moment compared to the control shoe. An ANOVA test was used to detect differences between interventions. Linear regression analysis was used to determine a relationship between the magnitude of the knee adduction moment prior to intervention and the effectiveness of the intervention in reducing the peak knee adduction moment. Peak knee adduction moments were reduced for the altered stiffness and altered angle shoes (p < 0.010), but not for the placebo shoe (p = 0.363). Additionally, linear regression analysis showed that subjects with higher knee adduction moments prior to intervention had larger reductions in the peak knee adduction moment (p < 0.010). These results demonstrate that shoe sole stiffness and angle interventions can be used to reduce the peak knee adduction moment and that subjects with initially higher peak knee adduction moments have higher reductions in their peak knee adduction moments.     

Six‐week gait retraining program reduces knee adduction moment,reduces pain,and improves function for individuals with medial compartment knee osteoarthritis

This study examined the influence of a 6‐week gait retraining program on the knee adduction moment (KAM) and knee pain and function. Ten subjects with medial compartment knee osteoarthritis and self‐reported knee pain participated in weekly gait retraining sessions over 6 weeks. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and a 10‐point visual‐analog pain scale score were measured at baseline, post‐training (end of 6 weeks), and 1 month after training ended. Gait retraining reduced the first peak KAM by 20% (p < 0.01) post‐training as a result of a 7° decrease in foot progression angle (i.e., increased internal foot rotation), compared to baseline (p < 0.01). WOMAC pain and function scores were improved at post‐training by 29% and 32%, respectively (p < 0.05) and visual‐analog pain scale scores improved by two points (p < 0.05). Changes in WOMAC pain and function were approximately 75% larger than the expected placebo effect (p < 0.05). Changes in KAM, foot progression angle, WOMAC pain and function, and visual‐analog pain score were retained 1 month after the end of the 6‐week training period (p < 0.05). These results show that a 6‐week gait retraining program can reduce the KAM and improve symptoms for individuals with medial compartment knee osteoarthritis and knee pain. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1020–1025, 2013     

The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial

Many conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA. Seventy individuals with medial knee OA underwent three‐dimensional walking gait analysis in five conditions (barefoot, control shoe, typical wedge, supported wedge, and mobility shoe) with pain and comfort recorded concurrently. The change in EKAM, KAAI, external knee flexion moment, pain, and comfort were assessed using multiple linear regressions and pairwise comparisons. Compared with the control shoe, lateral wedge insoles and barefoot walking significantly reduced early stance EKAM and KAAI. The mobility shoe showed no effect. A significant reduction in latter stance EKAM was seen in the lateral wedge insoles compared to the other conditions, with only the barefoot condition reducing the external knee flexion moment. However, the mobility shoe showed significant immediate knee pain reduction and improved comfort scores. Different lateral wedge insoles show comparable reductions in medial knee loading and in our study, the mobility shoe did not affect medial loading. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 33:1646–1654, 2015.     

Effects of lateral‐offset sole shoes on knee adduction moment in women with medial compartment knee osteoarthritis

This study aimed to determine the impact of wearing a lateral‐offset sole shoe (LOSS) on knee adduction moment (KAM) in patients with medial knee osteoarthritis (OA). From December 2012 to November 2016, patients with medial knee OA were recruited. Ninety‐three knees (50 left, 43 right) of 93 female patients were analyzed. The first peak KAMs were measured with patients (i) walking barefoot; (ii) walking in conventional shoes; and (iii) walking in LOSSs. The patients had grade 1 (n = 19), grade 2 (n = 49), grade 3 (n = 20), and grade 4 (n = 5) knee OA. First peak KAMs differed significantly in all three conditions (p = 0.031). In the post hoc analysis, first peak KAMs were significantly lower during LOSS walking than during conventional shoe walking (p = 0.001), but there were no differences in peak KAMs between barefoot and LOSS walking (p = 0.784). In the subgroup analysis, patients with grades 2 and 3 OA showed significantly lower first peak KAMs during LOSS walking than during conventional shoe walking (p = 0.029 and p = 0.011, respectively). Both the peak eversion ankle angle and moment of barefoot walking showed a significant increase compared with LOSS and conventional shoe walking, while there was no significant difference between LOSS and conventional shoe walking (p = 0.612 and p = 0.197, respectively). Our results suggest that LOSS wearing caused significant KAM reductions compared with conventional shoe wearing. Since LOSS wearing does not cause changes in the peak eversion ankle angle and moment during the load response, it may be an effective method to reduce the KAM in women with knee OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1694–1700, 2018.

     

Efetividade do plasma rico em plaquetas no tratamento da dor em osteoartrite de joelho: estudo comparativo randômico e duplo‐cego

BackgroundIntra‐articular injections of platelet‐rich plasma to treat symptoms of knee osteoarthritis have been successfully used in young patients. However in most of these studies the control and test knees were present in different patients thus incorporating a large amount of bias in the results. Therefore, the present study was designed in which patients with bilateral osteoarthritis knee were included and platelet‐rich plasma was administered in one knee and normal saline in another knee of same patient.Methods20 patients aged 30‐65 years with bilateral osteoarthritis knees (ASA class I and II) of either gender were included in the study. Patients were randomized to receive platelet‐rich plasma and normal saline in one of the two knees. The primary outcome was VAS and WOMAC score at 6 months after procedure. The secondary outcome included changes in joint stiffness, physical function, any adverse effects noted during the course of study.ResultsThe baseline VAS score in platelet‐rich plasma knee was 8.4 ± 0.88 which improved significantly to 4.85 ± 2.48 (p < 0.001) at 6 months as compared to normal saline knee (p = 0.017). The WOMAC pain score also improved from baseline (14.5 ± 1.3) to over 6 month 7.00 ± 4.24 (p < 0.001) in platelet‐rich plasma knee while in the normal saline knee, no significant change occurred from baseline to six months (10.2 ± 1.2 to 10.05 ± 1.23). There was also significant decrease in stiffness and improvement of physical activity in the platelet‐rich plasma knee as compared to normal saline knee.ConclusionThe present study showed significant decrease in pain and stiffness and improvement of physical functions of knee joint with intra‐articular platelet‐rich plasma injection as compared to normal saline.     

Does hip implant positioning affect the peak external adduction moments of the healthy knees of subjects with total hip replacements?

After unilateral total hip replacement (THR) for hip osteoarthritis (OA), knee OA incidence or progression is common. The contralateral knee is at particular risk, and some have speculated that abnormal THR‐hip biomechanics contributes to this asymmetry. We investigated the relationships between operated‐hip joint geometry or gait variables and the peak external knee adduction moments—an indicator of knee OA risk—in 21 subjects with unilateral THRs. We found that the peak adduction moment was 14% higher on the contralateral versus the ipsilateral knee (p = 0.131). The best predictors of ipsilateral knee adduction moments were superior‐inferior joint center position and operated‐hip peak adduction moment (adj R² = 0.291, p = 0.017). The sole predictor of the contralateral knee adduction moment was the medial‐lateral hip center position (adj R² = 0.266, p = 0.010). A postoperative medial shift of the hip center was significantly correlated with a lower postoperative contralateral/ipsilateral knee adduction moment ratio (R = 0.462, p = 0.035). Based on these relationships, we concluded that implant positioning could influence the biomechanical risk of knee OA progression after THR. Although implant positioning decisions are necessarily driven by other factors, it may be appropriate to assess individual THR candidate's knee OA risk and adjust perioperative management accordingly. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1187–1194, 2013     

Functional outcome and persistent disability after isolated fracture of the femur

Background

The purpose of this study was to assess the functional outcome and causes of persistent disability in patients with isolated femoral shaft fractures treated at an academic level-1 trauma centre.

Methods

We prospectively enrolled 40 consecutive skeletally mature patients with isolated, nonpathologic diaphyseal femur fractures. All patients underwent fracture reduction and fixation using an antegrade locked intramedullary nail. We measured functional outcome using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the Short Musculoskeletal Functional Assessment (SMFA). We obtained visual analog scores for pain in the groin, buttock, thigh and knee 6 months after the injury.

Results

Joint-related and musculoskeletal outcome scores improved gradually from the baseline assessment to the 6-month review. Mean scores (and standard deviations [SDs]) on the WOMAC index improved gradually from 57 (23) to 24 (22) for pain, from 57 (25) to 30 (20) for stiffness and from 70 (21) to 21 (23) for function (p < 0.001). The mean SMFA score (and SD) improved from 64 (13) to 25 (20) (p = 0.024). We noted no further improvements in functional outcome measures from the 6-month to the 12-month assessment (p > 0.21). Patients reported more pain in the knee than in other anatomic locations; the mean pain scores (and SDs) were 3.7 (3.1) in the knee, 2.5 (2.7) in the thigh, 1.7 (2.7) in the buttock and 1.0 (1.7) in the groin (p = 0.003). We noted correlations between knee pain and WOMAC pain (ρ = 0.748, p < 0.001), function (ρ = 0.701, p < 0.001) and SMFA (ρ = 0.733, p < 0.001). We noted weaker correlations between thigh, groin and buttock pain and functional outcomes, with ρ scores ranging from 0.2 to 0.55.

Conclusion

Recovery from femur fractures occurs most rapidly in the first 6 months after injury. Residual deficits in functional outcome were still measurable 12 months after injury. Knee pain was the most common and most severe source of patient discomfort 12 months after isolated femur fractures, and demonstrated moderate to good correlation with general and joint-specific functional outcome measures.     

The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain.

This study tested whether the peak external knee adduction moments during walking in subjects with knee osteoarthritis (OA) were correlated with the mechanical axis of the leg, radiographic measures of OA severity, toe out angle or clinical assessments of pain, stiffness or function. Gait analysis was performed on 62 subjects with knee OA and 49 asymptomatic control subjects (normal subjects). The subjects with OA walked with a greater than normal peak adduction moment during early stance (p = 0.027). In the OA group, the mechanical axis was the best single predictor of the peak adduction moment during both early and late stance (R = 0.74, p < 0.001). The radiographic measures of OA severity in the medial compartment were also predictive of both peak adduction moments (R = 0.43 to 0.48, p < 0.001) along with the sum of the WOMAC subscales (R = -0.33 to -0.31, p < 0.017). The toe out angle was predictive of the peak adduction moment only during late stance (R = -0.45, p < 0.001). Once mechanical axis was accounted for, other factors only increased the ability to predict the peak knee adduction moments by 10 18%. While the mechanical axis was indicative of the peak adduction moments, it only accounted for about 50% of its variation, emphasizing the need for a dynamic evaluation of the knee joint loading environment. Understanding which clinical measures of OA are most closely associated with the dynamic knee joint loads may ultimately result in a better understanding of the disease process and the development of therapeutic interventions.     

Abnormal loading of the hip and knee joints in unilateral hip osteoarthritis persists two years after total hip replacement

A total hip replacement (THR) is a common and routine procedure to reduce pain and restore normal activity. Gait analysis can provide insights into functional characteristics and dynamic joint loading situation not identifiable by clinical examination or static radiographic measures. The present prospective longitudinal study tested whether 2 years after surgery a THR would restore dynamic loading of the knee and hip joints in the frontal plane to normal. Instrumented gait analysis was performed shortly before surgery and approximately 2 years after THR on 15 unilateral hip osteoarthritis (OA) patients. 15 asymptomatic matched individuals were recruited as healthy controls. Results showed that abnormal joint loading persisted 2 years after THR. The 2nd external knee adduction moment in terminal stance in the affected (?34%, p = 0.002, d = 1.22) and non‐affected limb (?25%, p = 0.035, d = 0.81) was lower compared to controls and thus indicated a shift in the knee joint load distribution from medial to lateral. A correlation analysis revealed that a smaller hip range of motion explained 46% of 2nd knee adduction moment alterations. In contrast, the 2nd external hip adduction moment in terminal stance was postoperatively higher in the affected (+22%, p = 0.007, d = 1.04) and non‐affected limb (+22%, p = 0.005, d = 1.05). Here, 51% of 2nd hip adduction moment alterations can be explained with a greater hip adduction angle. Patients with a THR may therefore be at higher risk for abnormal joint loading and thus for the development of OA in other joints of the lower extremities. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2167–2177, 2018.

     

Effects of active feedback gait retraining to produce a medial weight transfer at the foot in subjects with symptomatic medial knee osteoarthritis

This study aimed to determine if active feedback gait retraining to produce a medial weight transfer at the foot significantly reduces the knee adduction moment in subjects with medial compartment knee osteoarthritis. Secondarily, changes in peak knee flexion moment, frontal plane knee and ankle kinematics, and center of pressure were investigated. Ten individuals with medial compartment knee osteoarthritis (9 males; age: 65.3 ± 9.8 years; BMI: 27.8 ± 3.0 kg/m²) were tested at self‐selected normal and fast speeds in two conditions: Intervention, with an active feedback device attached to the shoe of their more affected leg, and control, with the device de‐activated. Kinematics and kinetics were assessed using a motion capture system and force plate. The first peak, second peak, and impulse of the knee adduction moment were significantly reduced by 6.0%, 13.9%, and 9.2%, respectively, at normal speed, with reductions of 10.7% and 8.6% in first peak and impulse at fast speed, respectively, with the active feedback system, with no significant effect on the peak knee flexion moment. Significant reductions in peak varus knee angle and medialized center of pressure in the first half of stance were observed, with reductions in peak varus knee angle associated with reductions in the knee adduction moment. This study demonstrated that active feedback to produce a medial weight‐bearing shift at the foot reduces the peaks and impulse of the knee adduction moment in patients with medial compartment knee osteoarthritis. Future research should determine the long‐term effect of the active feedback intervention on joint loading, pain, and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2251–2259, 2017.

     

Chronic,Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

Chronic pain and restricted knee motion is a significant problem following the total knee arthroplasty (TKA). The molecular pathogenesis of pain post‐TKA is not known and no targeted therapeutic intervention is available. The aim of this study was to investigate whether pro‐inflammatory mediators are elevated in revision knee patients, indicating an active, ongoing inflammatory process that may contribute to pain. Twelve key markers (pro‐inflammatory cytokines granulocyte‐macrophage colony‐stimulating factor [GM‐CSF], interleukin 5 [IL‐5], IL‐8 and IL‐10, chemokines CCL2, CCL3, CCL4, and CCL13, mediators of angiogenesis Flt‐1, vascular endothelial growth factor, and cell migration vascular cell adhesion molecule 1 and intercellular adhesion molecule 1) were measured in knee tissue and synovial fluid (SF) from primary TKA (n = 29) and revision patients (n = 32). Indications for surgery were osteoarthritis (OA) for primary TKA, and component loosening (n = 11), stiffness (n = 11), laxity pattern (n = 8), or progression of OA in patella resurfacing (n = 3) for revision surgery. Pain levels (WOMAC score) were higher in revision than primary patients (p ≤ 0.05). Time from primary to revision ranged from 8 months to 30 years (median 10 years). All markers were elevated in revision TKA; there was no trend toward decreasing levels with greater time from primary surgery for any marker studied in SF. Similar results were seen in knee tissue. We found no differences comparing indications for revision surgery (p ≥ 0.05). The elevation of inflammatory mediators in painful post‐TKA knees requiring revision suggests active, chronic inflammation. Characterization of upregulated markers provides rationale for targeted therapy, even many years from the primary surgery. © 2019 The Authors. Journal of Orthopaedic Research^® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2316–2324, 2019     

Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after 1 year of wear

The use of lateral foot wedging in the management of medial knee osteoarthritis is under scrutiny. Interestingly, there have been minimal efforts to evaluate biomechanical effectiveness with long‐term use. Therefore, we aimed to evaluate dynamic knee loading (assessed using the knee adduction moment) and other secondary gait parameters in patients with medial knee osteoarthritis wearing lateral foot wedging at a baseline visit and after 1 year of wear. Three‐dimensional gait data were captured in an intervention group of 19 patients with symptomatic medial knee osteoarthritis wearing their prescribed laterally wedged foot orthoses at 0 and 12 months. Wedge amounts were prescribed based on symptom response to a step‐down test. A control group of 19 patients wearing prescribed neutral orthoses were also captured at 0 and 12 months. The gait of the intervention group wearing neutral orthoses was additionally captured. Walking speed and shoes were controlled. Analyses of variance were conducted to examine for group‐by‐time (between the groups in their prescribed orthoses) and condition‐by‐time (within the intervention group) interactions, main effects, and simple effects. We observed increased knee adduction moments and frontal plane motion over time in the control group but not the intervention group. Further, within the intervention group, the mechanical effectiveness of the lateral wedging did not decrease. In patients with medial knee osteoarthritis, the effects of lateral foot wedging on pathomechanics associated with medial knee osteoarthritis were favorable and sustained over time. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 659–664, 2013     

The relationship between reductions in knee loading and immediate pain response whilst wearing lateral wedged insoles in knee osteoarthritis

Studies of lateral wedge insoles (LWIs) in medial knee osteoarthritis (OA) have shown reductions in the average external knee adduction moment (EKAM) but no lessening of knee pain. Some treated patients actually experience increases in the EKAM which could explain the overall absence of pain response. We examined whether, in patients with painful medial OA, reductions in the EKAM were associated with lessening of knee pain. Each patient underwent gait analysis whilst walking in a control shoe and two LWI's. We evaluated the relationship between change in EKAM and change in knee pain using Spearman Rank Correlation coefficients and tested whether dichotomizing patients into biomechanical responders (decreased EKAM) and non‐responders (increased EKAM) would identify those with reductions in knee pain. In 70 patients studied, the EKAM was reduced in both LWIs versus control shoe (?5.21% and ?6.29% for typical and supported wedges, respectively). The change in EKAM using LWIs was not significantly associated with the direction of knee pain change. Further, 54% were biomechanical responders, but these persons did not have more knee pain reduction than non‐responders. Whilst LWIs reduce EKAM, there is no clearcut relationship between change in medial load when wearing LWIs and corresponding change in knee pain. © 2014 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 32:1147–1154, 2014.

     

Is There a Threshold for Stiffness Complaints Following TKA on the WOMAC Stiffness Subscale?

Background

Stiffness complaints after total knee arthroplasty (TKA) are frequent, yet poorly understood and can be challenging for surgeons to address. The WOMAC stiffness subscale is a widely used measure of stiffness and can serve as a simple screening tool for complaints.

Questions/Purposes

We aimed to identify a threshold for stiffness complaints on the WOMAC stiffness subscale and investigate its overlap with range of motion (ROM) in TKA patients.

Methods

TKA patients were enrolled preoperatively and followed for 6 months. At follow-up, patients reported their ROM, completed the WOMAC stiffness subscale (range 1–8 with 8 continuous stiffness) and indicated whether they experienced more stiffness than expected. To identify a threshold for complaints, we compared patients’ WOMAC stiffness scores to when they experienced more stiffness than expected, visually, and statistically. We also mapped ROM limitations at 6 months to WOMAC stiffness scores. Finally, we determined if baseline characteristics were associated with stiffness complaints.

Results

Two hundred and forty-six TKA patients were enrolled preoperatively with 82% follow-up rate at 6 months. Our results showed that patients with a WOMAC stiffness score?=?3+ were significantly more likely to experience more stiffness than expected. Patients reporting full ROM (54%) reported a wide range of WOMAC stiffness subscale scores (1–6). Baseline WOMAC pain and function scores were the only factors associated with stiffness complaints.

Conclusions

ROM is a poor surrogate of patient-reported stiffness, and the patients’ perception of “stiffness” is clearly more complex than just ROM. We identified a WOMAC threshold that could potentially easily serve this purpose.

     

Comparing Two Orthoses for Managing Medial Knee Osteoarthritis: Lateral Wedge with Subtalar Strap While Barefoot Versus Lateral Wedged Insole Fitted Within Sandal

BackgroundUsing foot orthoses for managing medial knee osteoarthritis (MKOA) is common, although its effectiveness is in debate. Most orthoses are placed inside the shoe as a lateral wedged insole. Thus, most studies in this area have focused on the effect of insoles used with shoes. This study compared the effects of a lateral wedge with subtalar strap (combined insole) used while barefoot and lateral wedged insole fitted within sandal on pain, function and external knee adduction moment (EKAM) in patients with MKOA to consider which orthotic treatment is better.MethodsIn this quasi-experimental pretest–posttest study, 29 participants with medial knee osteoarthritis were divided into two groups: (1) combined insole (n = 15) and (2) sandal (n = 14) groups. We recorded their gait while walking with and without orthoses using a motion analysis system. We evaluated their pain and performance with visual analog scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, 30 s chair stand, and Timed Up and Go functional tests. The pain and performance evaluations were repeated after one month.ResultsThe pain immediately decreased after walking with both orthoses (p < 0.001). There was no significant difference in EKAM results between the two orthoses. Pain and performance improved in both groups after a one month using the orthoses (p < 0.01).ConclusionBoth types of orthoses have similar effect and lead to better performance and less pain after 1 month.     

对侧膝关节疼痛对全膝关节置换手术患者的临床影响

目的:评估对侧膝关节疼痛程度对骨性关节炎患者全膝关节置换术(total knee arthroplasty,TKA)后1年手术侧关节功能障碍及治疗满意度的影响。方法:2019年3月至2021年1月行TKA的635例患者,男296例,女339例;年龄(69.33±9.38)岁,病程(1.15±0.44)年。根据术后对侧膝关节疼痛视觉模拟评分(visual analogue scale,VAS)分为轻度或无疼痛(VAS 0～3分)423例,中度疼痛(VAS 4～6分)105例,重度疼痛(VAS 7～10分)107例。分析比较对侧膝关节不同疼痛程度对术后12个月膝关节功能及满意度评分的影响。结果:对侧膝关节疼痛VAS在TKA术后明显降低,年龄大、身体质量指数高、术后手术侧膝关节WOMAC评分高、对侧膝关节中、重度疼痛是患者不满意的危险因素(P<0.05),OR分别为1.285、1.665、2.319、1.863。手术侧膝关节疼痛度高、居家环境为步梯房是患者出院1年后WOMAC评分高的危险因素(P<0.05);出院后坚持锻炼、功能性训练是患者出院1年后WOMAC评分高的保护因素(P...     

Proximal gait adaptations in medial knee OA

The purpose of this study was to examine interlimb differences in gait kinematics and kinetics in patients with symptomatic medial knee OA. The main objective was to identify hip joint movement strategies that might lower the knee adduction moment and also compensate for decreased knee flexion during weight acceptance. Gait analysis was performed on 32 patients with moderate medial compartment knee OA. Kinetic and kinematic data were calculated and side‐to‐side comparisons made. Radiographs were used to identify frontal plane alignment. No interlimb difference in the peak knee adduction moment was found (p = 0.512), whereas a greatly reduced hip adduction moment was seen on the involved side (p < 0.001) during the early part of stance. The involved limb flexed significantly less and hip and knee flexion moments were smaller compared to the uninvolved side. Gait adaptations involving a lateral sway of the trunk may successfully lead to relatively lower ipsilateral knee adduction moments, and would further be reflected by a lower adduction moment at the hip. Subjects did not compensate for less knee flexion by any dynamic means, and likely experience a resulting higher joint impact. These gait adaptations may have implications with respect to development of weakness of the ipsilateral hip musculature and progression of multiarticular OA. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:78–83, 2009     

Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study

Objective

To assess health-related quality of life (HRQOL) in a prospective study with 7?years of follow-up in 49 consecutive patients who underwent a total joint replacement because of osteoarthritis.

Methods

Generic HRQOL was assessed with the short-form 36 (SF-36) and specific HRQOL with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results

Out of the 39 subjects who have completed the 7?years of follow-up of this study, 22 (56.4?%) underwent a hip replacement surgery and the other 17 (43.6?%) a knee replacement. Six months after surgery, a significant improvement, compared to preoperative scores, was observed in two of the eight dimensions of the SF-36 (i.e. physical function and pain). The same dimensions, pain and physical function, at the same time, 6?months after surgery, measured by the WOMAC, showed a significant improvement as well, but there was no significant change in the stiffness score. From 6?months to the end of follow-up, changes in SF-36 scores showed a significant improvement in physical function (p?=?0.008), role-physical (p?=?0.004) and role-emotional (p?=?0.01) while all scores of the WOMAC improved (p?<?0.001 for pain, p?<?0.001 for stiffness and p?<?0.01 for physical function).

Conclusion

The improvements observed in HRQOL at short term after surgery, are at least maintained over a 7-year follow-up period.