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Wada M, Yamamoto Y, Hirai T, Kubota A, Takeura N, Adachi T. Use of accelerometry to detect varus thrust of osteoarthritic knees before and one year after high tibial osteotomy. J Orthop Sci 2024:S0949-2658(24)00092-7. [PMID: 38760247 DOI: 10.1016/j.jos.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/05/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The purpose of this study was to determine the effects of high tibial osteotomy (HTO) on varus thrust during gait in patients with medial compartment knee osteoarthritis (KOA), and to identify factors that influence thrust before and one year after surgery. METHODS HTO was performed in 60 KOA patients (70 knees, including 56 knees by open wedge and 14 by closed wedge). The control group comprised 28 normal, control subjects. Several parameters were evaluated before surgery and one year thereafter. Varus thrust was defined as acceleration of the thigh relative to the lower leg in the coronal plane. Knee-injury-and-osteoarthritis-outcome scores (KOOSs), knee joint angles, radiography, and mediolateral knee acceleration during free speed gait were measured and analyzed. RESULTS One-year after HTO, KOOSs, knee extension angles, and range of knee motion were improved (p < 0.001). The hip-knee-ankle angle and joint-line-convergent angle (JLCA) had decreased (p < 0.001), and walking speed had increased (p < 0.001). Preoperatively, patient acceleration was significantly (p < 0.05) higher than that of controls, and it did not change after HTO. However, it was reduced significantly (p < 0.05) after adjusting for walking speed. Walking speed correlated significantly with acceleration preoperatively, postoperatively, and among controls. Surgical methods (open-wedge/closed-wedge HTO) and correction angle did not affect postoperative acceleration. There was a low correlation between acceleration and KOOSs (KOOSa, KOOSp), knee joint angles, or JLCA postoperatively, but no relationship was found between acceleration and these parameters in the preoperative or the control group. CONCLUSIONS Walking speed correlated significantly with acceleration preoperatively, postoperatively, and with those of controls. Mediolateral acceleration of the thigh relative to the lower leg in patients with KOA was significantly higher than that of normal controls before surgery, and it did not change after HTO. However, after surgery it was reduced significantly after adjusting for walking speed.
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Affiliation(s)
- Makoto Wada
- Department of Orthopedic Surgery, Tan-nan Regional Medical Center, Fukui, Japan
| | - Yusuke Yamamoto
- Department of Orthopedic Surgery, Tan-nan Regional Medical Center, Fukui, Japan.
| | - Takayuki Hirai
- Department of Orthopedic Surgery, Tan-nan Regional Medical Center, Fukui, Japan
| | - Arisa Kubota
- Department of Orthopedic Surgery, Tan-nan Regional Medical Center, Fukui, Japan
| | - Naoto Takeura
- Department of Orthopedic Surgery, Tan-nan Regional Medical Center, Fukui, Japan
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Iwasaki K, Ohkoshi Y, Hosokawa Y, Chida S, Ukishiro K, Kawakami K, Suzuki S, Maeda T, Onodera T, Kondo E, Iwasaki N. Higher Association of Pelvis-Knee-Ankle Angle Compared With Hip-Knee-Ankle Angle With Knee Adduction Moment and Patient-Reported Outcomes After High Tibial Osteotomy. Am J Sports Med 2023; 51:977-984. [PMID: 36786244 DOI: 10.1177/03635465221150513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) reduces the load distribution of the medial compartment by modifying leg alignment. Knee adduction moment (KAM), a surrogate measure of dynamic loading in the knee joint, decreases after HTO. However, leg alignment does not fully account for KAM. PURPOSE To assess the association between the pelvis-knee-ankle angle (PKA), a novel radiographic parameter reflecting leg alignment and pelvic width, and KAM and patient-reported outcomes after HTO. STUDY DESIGN Cross sectional study; Level of evidence, 3. METHODS PKA is the angle between the line from the midpoint of the anterior superior iliac spine to the center of the knee joint and the mechanical axis of the tibia. In this study, 54 patients with medial compartment knee osteoarthritis and varus alignment who underwent 3-dimensional gait analysis preoperatively and 2 years after medial open-wedge HTO were evaluated. The primary outcomes were hip-knee-ankle angle (HKA), PKA, KAM peaks, and Knee Society Score (KSS). Single and multivariate regression analysis including PKA and KAM peaks as well as other demographic and radiologic factors was performed. RESULTS HKA was weakly correlated with the first peak KAM (r = -0.33; P < .01) and second peak KAM (r = -0.27; P = .01) before HTO, but not significantly correlated after HTO. PKA was moderately correlated with the first peak KAM (r = 0.45; P < .01) and second peak KAM (r = 0.45; P < .01) before HTO and with the first peak KAM (r = 0.51; P < .01) and second peak KAM (r = 0.56; P < .01) after HTO. Multivariate linear regression revealed that postoperative PKA was still associated with the KAM peaks after HTO. Only postoperative PKA was correlated with the KSS satisfaction subscale (r = -0.30; P = .03). CONCLUSION Although HKA was not correlated with KAM peaks after HTO, PKA was significantly correlated with KAM peaks in patients with varus knee osteoarthritis after HTO.
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Affiliation(s)
- Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Yoshiaki Hosokawa
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shuya Chida
- Department of Rehabilitation, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Kengo Ukishiro
- Department of Rehabilitation, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Kensaku Kawakami
- Department of Production Systems Engineering, National Institute of Technology, Hakodate College, Hakodate, Japan
| | - Sho'ji Suzuki
- Department of Complex and Intelligent Systems, Future University Hakodate, Hakodate, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Rokhmanova N, Kuchenbecker KJ, Shull PB, Ferber R, Halilaj E. Predicting knee adduction moment response to gait retraining with minimal clinical data. PLoS Comput Biol 2022; 18:e1009500. [PMID: 35576207 PMCID: PMC9135336 DOI: 10.1371/journal.pcbi.1009500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/26/2022] [Accepted: 04/23/2022] [Indexed: 11/24/2022] Open
Abstract
Knee osteoarthritis is a progressive disease mediated by high joint loads. Foot progression angle modifications that reduce the knee adduction moment (KAM), a surrogate of knee loading, have demonstrated efficacy in alleviating pain and improving function. Although changes to the foot progression angle are overall beneficial, KAM reductions are not consistent across patients. Moreover, customized interventions are time-consuming and require instrumentation not commonly available in the clinic. We present a regression model that uses minimal clinical data—a set of six features easily obtained in the clinic—to predict the extent of first peak KAM reduction after toe-in gait retraining. For such a model to generalize, the training data must be large and variable. Given the lack of large public datasets that contain different gaits for the same patient, we generated this dataset synthetically. Insights learned from a ground-truth dataset with both baseline and toe-in gait trials (N = 12) enabled the creation of a large (N = 138) synthetic dataset for training the predictive model. On a test set of data collected by a separate research group (N = 15), the first peak KAM reduction was predicted with a mean absolute error of 0.134% body weight * height (%BW*HT). This error is smaller than the standard deviation of the first peak KAM during baseline walking averaged across test subjects (0.306%BW*HT). This work demonstrates the feasibility of training predictive models with synthetic data and provides clinicians with a new tool to predict the outcome of patient-specific gait retraining without requiring gait lab instrumentation. Gait retraining is a conservative intervention for knee osteoarthritis shown to reduce pain and improve function. Although customizing a treatment plan for each patient results in a better therapeutic response, customization cannot yet be performed outside of the gait laboratory, preventing research advances from becoming part of clinical practice. Our work aimed to build a model that accurately predicts whether a patient with knee osteoarthritis will benefit from non-invasive gait retraining using measures that can be easily collected in the clinic. To overcome the lack of large datasets required to train predictive models, we generated data synthetically (N = 138) based on limited ground-truth examples, and we provide experimental evidence for the model’s ability to generalize to real data (N = 15). Our results contribute toward a future in which clinicians can use data collected in the clinic to easily identify patients who would respond to therapeutic gait retraining.
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Affiliation(s)
- Nataliya Rokhmanova
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
- Max Planck Institute for Intelligent Systems, Stuttgart, Germany
| | | | - Peter B. Shull
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Eni Halilaj
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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A Conceptual Blueprint for Making Neuromusculoskeletal Models Clinically Useful. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052037] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The ultimate goal of most neuromusculoskeletal modeling research is to improve the treatment of movement impairments. However, even though neuromusculoskeletal models have become more realistic anatomically, physiologically, and neurologically over the past 25 years, they have yet to make a positive impact on the design of clinical treatments for movement impairments. Such impairments are caused by common conditions such as stroke, osteoarthritis, Parkinson’s disease, spinal cord injury, cerebral palsy, limb amputation, and even cancer. The lack of clinical impact is somewhat surprising given that comparable computational technology has transformed the design of airplanes, automobiles, and other commercial products over the same time period. This paper provides the author’s personal perspective for how neuromusculoskeletal models can become clinically useful. First, the paper motivates the potential value of neuromusculoskeletal models for clinical treatment design. Next, it highlights five challenges to achieving clinical utility and provides suggestions for how to overcome them. After that, it describes clinical, technical, collaboration, and practical needs that must be addressed for neuromusculoskeletal models to fulfill their clinical potential, along with recommendations for meeting them. Finally, it discusses how more complex modeling and experimental methods could enhance neuromusculoskeletal model fidelity, personalization, and utilization. The author hopes that these ideas will provide a conceptual blueprint that will help the neuromusculoskeletal modeling research community work toward clinical utility.
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Fantini Pagani C, Funken J, Heinrich K, Ellermann A, Schmidt-Wiethoff R, Potthast W. Predicting the knee adduction moment after high tibial osteotomy in patients with medial knee osteoarthritis using dynamic simulations. Knee 2020; 27:61-70. [PMID: 31883857 DOI: 10.1016/j.knee.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/24/2019] [Accepted: 08/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a surgical treatment for knee osteoarthritis, which alters the load distribution in the tibiofemoral joint. To date, all surgical planning methods are based on radiographs, which do not consider the loading characteristics during ambulation. This study aimed to develop and validate a simulation tool for predicting the knee adduction moment (KAM) expected after a HTO using the patient pre-operative gait analysis data and dynamic simulations. METHODS Ten patients selected for a HTO underwent a gait analysis before surgery. Pre-operative gait data along with the planned correction angle were used for simulation of the KAM expected after leg realignment. After surgery, the same procedures of gait analysis were performed and post-operative KAM was compared to the simulation results. RESULTS Significant reductions of the KAM were observed after surgery. During gait at 1.2 m/s, means of the 1st peak KAM were 3.19 ± 1.03 (standard deviation), 1.21 ± 0.80 and 1.21 ± 0.71% BW × Ht for the conditions pre-operative, post-operative and simulation, respectively. Mean root-mean-square error for the KAM was 0.45% BW × Ht (range: 0.23-0.78% BW × Ht) and Lin's concordance coefficient for the 1st peak KAM was 0.813. An individual analysis showed high agreement for several patients and lower agreement for others. Possible changes in gait pattern after surgery may explain this variability. CONCLUSION A novel approach for surgical planning based on dynamic loading of the knee during ambulation is presented. The simulation tool is based on patient-specific gait characteristics and may improve the surgical planning procedures used to date.
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Affiliation(s)
- Cynthia Fantini Pagani
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Johannes Funken
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Kai Heinrich
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Andree Ellermann
- ARCUS Clinics Pforzheim, Rastatter Str. 17-19, 75179 Pforzheim, Germany.
| | | | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany; ARCUS Clinics Pforzheim, Rastatter Str. 17-19, 75179 Pforzheim, Germany.
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Morin V, Pailhé R, Duval BR, Mader R, Cognault J, Rouchy RC, Saragaglia D. Gait analysis following medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2018; 26:1838-1844. [PMID: 28251263 DOI: 10.1007/s00167-017-4421-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE High tibial osteotomy (HTO) is used to treat young and active patients with knee osteoarthritis (OA) and varus deformity. The medial compartment OA alters the patients' gait. METHODS A prospective study was carried out in 21 consecutive patients operated for HTO due to knee OA with varus deformity. There were 14 men and 7 women, with a median age of 51.9 years (38-64). Their gait was analyzed preoperatively and at 1 year postoperatively, and compared to a healthy control group. Clinical assessment (KOOS, WOMAC, Lysholm, and SF-36 scores) was also performed preoperatively and postoperatively. RESULTS Patients with medial compartment OA had altered gait relative to the control population. Their walking speed was slower, step length was shorter, and single-leg stance time was shorter, while the double-leg stance time was longer (P < 0.001). Step width was not different between the two groups preoperatively (n.s.), but it was wider in the patient group postoperatively (P = 0.003). There were no differences in the patients' gait parameters before and after the osteotomy (n.s.). However, there was an improved perception of walking so that it is no longer different from controls (n.s.). The KOOS, WOMAC, Lysholm and SF-36 scores improved after HTO. The preoperative median of 7° varus (1-11) was corrected to 3° valgus (0-6). CONCLUSION Medial compartment OA with varus deformity leads to gait modifications. HTO does not alter the time-distance parameters of gait; however, patients have improved perception of their walking ability. HTO leads to excellent results for knee function, and improves quality of life without modifying the gait pattern. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Vincent Morin
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France.
| | - Régis Pailhé
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Brice Rubens Duval
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Roch Mader
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Jérémy Cognault
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - René-Christopher Rouchy
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Dominique Saragaglia
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
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Gait analysis in short-term follow-up of medial opening wedge high tibial osteotomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:939-946. [PMID: 29234863 DOI: 10.1007/s00590-017-2099-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Biomechanical gait changes are proposed as adaptations to medial knee osteoarthritis (OA), and little is known about which parameters can be modified early by high tibial osteotomy (HTO) surgery. The aim of this study was to identify early gait changes in a postoperative period of 6 months as compared to a control group, in three different spatial planes. METHODS Twenty-one patients with OA were submitted to three-dimensional gait analysis preoperatively and 6 months after HTO surgery. Sixteen healthy individuals were selected for the control group. RESULTS Compared to the control group, OA patients walked more slowly, with a shorter stride length, and with a higher knee varus and flexion angles. The gait changes detected in the postoperative of 6 months were a significant reduction in knee varus angle and adductor moment in coronal plane; an important reduction in knee extension and an increased extensor moment in sagittal plane; also an increased foot external rotation angle in axial plane was observed. Flexion angle peak in swing phase, adductor and flexor moments were the gait parameters with postoperatively results that were closer to those of the control group. CONCLUSIONS Even in a short follow-up of 6 months, HTO determines positive results in biomechanical gait, not only in the coronal plane but also in the sagittal and axial planes and should be taken into account during the rehabilitation process.
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Birmingham TB, Moyer R, Leitch K, Chesworth B, Bryant D, Willits K, Litchfield R, Fowler PJ, Giffin JR. Changes in biomechanical risk factors for knee osteoarthritis and their association with 5-year clinically important improvement after limb realignment surgery. Osteoarthritis Cartilage 2017; 25:1999-2006. [PMID: 28888904 DOI: 10.1016/j.joca.2017.08.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 07/18/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate 5-year outcomes after lower limb realignment and test the hypothesis that surgery-induced changes in selected biomechanical risk factors for medial knee osteoarthritis (OA) are associated with clinically important improvements. DESIGN We prospectively evaluated patient-reported outcomes, full-limb standing radiographs and gait biomechanics before, 6 months (surgery-induced change) and 5 years after medial opening wedge high tibial osteotomy (HTO) in 170 patients (46.4 ± 8.9 years, 135 males) with knee OA and varus alignment. Logistic regression tested the associations of 6-month changes in mechanical axis angle and knee adduction moment with achieving an increase of ≥10 points in the Knee injury and Osteoarthritis Outcome Score (KOOS)4 at 5 years, with and without adjusting for covariates. Gait data were also compared to existing data from healthy controls. RESULTS Mean 5-year changes (95% confidence interval (CI)) were: KOOS4: +14.2 (10.8, 17.6); mechanical axis angle: +8.21° (7.58, 8.83); knee adduction moment: -1.49 %BW*Ht (-1.35, -1.63). The postoperative knee adduction moments were typically lower than values for healthy controls. When divided into quartiles, although all strata improved significantly, patients with reductions in knee adduction moment of 1.14-1.74 %BW*Ht (neither largest nor smallest changes) had highest 5-year KOOS4 scores. The 6-month change in knee adduction moment (odds ratios (OR) = 0.38; 95% CI: 0.22, 0.67), preoperative KOOS4 (OR = 0.96; 95% CI: 0.94, 0.99) and preoperative medial tibiofemoral narrowing grade (OR = 0.62; 95% CI: 0.37, 1.00) were negatively associated with having a 5-year clinically important improvement (C-statistic = 0.70). CONCLUSIONS Substantial improvements in biomechanical risk factors and patient-reported outcomes are observed 5 years after medial opening wedge HTO. The surgery-induced change in load distribution during walking is significantly associated with long-term clinically important improvement.
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Affiliation(s)
- T B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - R Moyer
- School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - K Leitch
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - B Chesworth
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - D Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - K Willits
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - R Litchfield
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - P J Fowler
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - J R Giffin
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
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Erhart-Hledik JC, Asay JL, Clancy C, Chu CR, Andriacchi TP. Effects of active feedback gait retraining to produce a medial weight transfer at the foot in subjects with symptomatic medial knee osteoarthritis. J Orthop Res 2017; 35:2251-2259. [PMID: 28120496 PMCID: PMC5524606 DOI: 10.1002/jor.23527] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/19/2017] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Jennifer C. Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jessica L. Asay
- Department of Mechanical Engineering, Stanford University, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Caitlin Clancy
- Department of Mechanical Engineering, Stanford University, Stanford, CA
| | - Constance R. Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Thomas P. Andriacchi
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Department of Mechanical Engineering, Stanford University, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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Lee SH, Lee OS, Teo SH, Lee YS. Change in gait after high tibial osteotomy: A systematic review and meta-analysis. Gait Posture 2017; 57:57-68. [PMID: 28577508 DOI: 10.1016/j.gaitpost.2017.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/10/2017] [Accepted: 05/23/2017] [Indexed: 02/02/2023]
Abstract
We conducted a meta-analysis to analyze how high tibial osteotomy (HTO) changes gait and focused on the following questions: (1) How does HTO change basic gait variables? (2) How does HTO change the gait variables in the knee joint? Twelve articles were included in the final analysis. A total of 383 knees was evaluated. There were 237 open wedge (OW) and 143 closed wedge (CW) HTOs. There were 4 level II studies and 8 level III studies. All studies included gait analysis and compared pre- and postoperative values. One study compared CWHTO and unicompartmental knee arthroplasty (UKA), and another study compared CWHTO and OWHTO. Five studies compared gait variables with those of healthy controls. One study compared operated limb gait variables with those in the non-operated limb. Gait speed, stride length, knee adduction moment, and lateral thrust were major variables assessed in 2 or more studies. Walking speed increased and stride length was increased or similar after HTO compared to the preoperative value in basic gait variables. Knee adduction moment and lateral thrust were decreased after HTO compared to the preoperative knee joint gait variables. Change in co-contraction of the medial side muscle after surgery differed depending on the degree of frontal plane alignment. The relationship between change in knee adduction moment and change in mechanical axis angle was controversial. Based on our systematic review and meta-analysis, walking speed and stride length increased after HTO. Knee adduction moment and lateral thrust decreased after HTO compared to the preoperative values of gait variables in the knee joint.
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Affiliation(s)
- Seung Hoon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - O-Sung Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Seow Hui Teo
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Malaysia
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
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Gait analysis before and after corrective osteotomy in patients with knee osteoarthritis and a valgus deformity. Knee Surg Sports Traumatol Arthrosc 2017; 25:2904-2913. [PMID: 26891964 PMCID: PMC5570791 DOI: 10.1007/s00167-016-4045-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE In this prospective study, the changes in kinetics and kinematics of gait and clinical outcomes after a varus osteotomy (tibial, femoral or double osteotomy) in patients with osteoarthritis (OA) of the knee and a valgus leg alignment were analysed and compared to healthy subjects. METHODS Twelve patients and ten healthy controls were included. Both kinetics and kinematics of gait and clinical and radiographic outcomes were evaluated. RESULTS The knee adduction moment increased significantly postoperatively (p < 0.05) and almost similar to the control group. Patients showed less knee and hip flexion/extension motion and moment during gait pre- and postoperatively compared to the controls. A significant improvement was found in WOMAC [80.8 (SD 16.1), p = 0.000], KOS [74.9 (SD 14.7), p = 0.018], OKS [21.2 (SD 7.5), p = 0.000] and VAS-pain [32.9 (SD 20.9), p = 0.003] in all patients irrespective of the osteotomy technique used. The radiographic measurements showed a mean hip knee ankle (HKA) angle correction of 10.4° (95 % CI 6.4°-14.4°). CONCLUSION In patients with knee OA combined with a valgus leg alignment, the varus-producing osteotomy is a successful treatment. Postoperatively, the patients showed kinetics and kinematics of gait similar as that of a healthy control group. A significant increase in the knee adduction moment during stance phase was found, which was related to the degree of correction. The HKA angle towards zero degrees caused a medial shift in the dynamic knee loading. The medial shift will optimally restore cartilage loading forces and knee ligament balance and reduces progression of OA or the risk of OA. A significant improvement in all clinical outcomes was also found. LEVEL OF EVIDENCE III.
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High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis. J Orthop Traumatol 2016; 17:277-85. [PMID: 27358200 PMCID: PMC4999379 DOI: 10.1007/s10195-016-0413-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/14/2016] [Indexed: 01/13/2023] Open
Abstract
High tibial osteotomy (HTO) has traditionally been used to treat varus gonarthrosis in younger, active patients. Varus malalignment increases the risk of progression of medial compartment osteoarthritis and an HTO can be performed to realign the mechanical axis of the lower limb towards the lateral compartment, thereby decreasing contact pressures in the medial compartment. Anterior cruciate ligament (ACL) insufficiency may lead to post-traumatic arthritis due to altered joint loading and associated injuries to the menisci and articular cartilage. Understanding the importance of posterior tibial slope and its role in sagittal knee stability has led to the development of biplane osteotomies designed to flatten the posterior tibial slope in the ACL deficient knee. Altering the alignment in both the sagittal and coronal planes helps improve stability as well as alter the load in the medial compartment. Detailed history, physical exam and radiographic analysis guide treatment decisions in this high demand patient population. Lateral closing wedge (LCW) and medial opening wedge (MOW) HTOs have been performed and their potential advantages and disadvantages have been well described. Given the triangular shape of the proximal tibia, it is imperative that the surgeon pay close attention to the geometry of the osteotomy “gap” when performing MOW HTO to avoid inadvertently increasing the posterior tibial slope. Simultaneous ACL reconstruction may require technique modifications depending on the type of HTO and ACL graft chosen. With appropriate patient selection and good surgical technique, it is reasonable to expect patients to return to activities of daily living and recreational sports without debilitating pain or instability.
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Yamaguchi S, Kitamura M, Ushikubo T, Murata A, Akagi R, Sasho T. Effect of Laterally Wedged Insoles on the External Knee Adduction Moment across Different Reference Frames. PLoS One 2015; 10:e0138554. [PMID: 26397375 PMCID: PMC4580408 DOI: 10.1371/journal.pone.0138554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/01/2015] [Indexed: 11/25/2022] Open
Abstract
Objective Biomechanical effects of laterally wedged insoles are assessed by reduction in the knee adduction moment. However, the degree of reduction may vary depending on the reference frame with which it is calculated. The purpose of this study was to clarify the effect of reference frame on the reduction in the knee adduction moment by laterally wedged insoles. Methods Twenty-nine healthy participants performed gait trials with a laterally wedged insole and with a flat insole as a control. The knee adduction moment, including the first and second peaks and the angular impulse, were calculated using four different reference frames: the femoral frame, tibial frame, laboratory frame and the Joint Coordinate System. Results There were significant effects of reference frame on the knee adduction moment first and second peaks (P < 0.001 for both variables), while the effect was not significant for the angular impulse (P = 0.84). No significant interaction between the gait condition and reference frame was found in either of the knee adduction moment variables (P = 0.99 for all variables), indicating that the effects of laterally wedged insole on the knee adduction moments were similar across the four reference frames. On the other hand, the average percent changes ranged from 9% to 16% for the first peak, from 16% to 18% for the second peak and from 17% to 21% for the angular impulse when using the different reference frames. Conclusion The effects of laterally wedged insole on the reduction in the knee adduction moment were similar across the reference frames. On the other hand, Researchers need to recognize that when the percent change was used as the parameter of the efficacy of laterally wedged insole, the choice of reference frame may influence the interpretation of how laterally wedged insoles affect the knee adduction moment.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
- * E-mail:
| | - Masako Kitamura
- Division of Rehabilitation Medicine, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | | | - Atsushi Murata
- Division of Rehabilitation Medicine, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
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Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent. Gait Posture 2015; 42:165-71. [PMID: 26091972 DOI: 10.1016/j.gaitpost.2015.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/27/2015] [Accepted: 05/10/2015] [Indexed: 02/02/2023]
Abstract
Medial opening wedge high tibial osteotomy is a surgical procedure intended to redistribute loads on the knee in patients with medial compartment knee osteoarthritis (OA). The surgery may affect moments in multiple planes during ambulation, with potential beneficial or detrimental effects on joint loads. The objective of this study was to investigate three-dimensional external knee moments before and after medial opening wedge high tibial osteotomy during level walking and during stair ascent. Fourteen patients with varus alignment and osteoarthritis primarily affecting the medial compartment of the tibiofemoral joint were assessed. Three-dimensional motion analyses during level walking and stair ascent was evaluated using inverse dynamics before, 6 and 12 months after surgery. Mean changes at 12 months suggested decreases in the peak knee adduction, flexion and internal rotation moments, with standardized response means ranging from 0.15 to 2.54. These decreases were observed despite increases in speed. Changes in alignment were associated with changes in the adduction and internal rotation moments, but not the flexion moment. Both pre- and postoperatively, the peak knee adduction moment was significantly lower (p=0.001) during stair ascent than during level walking, while the flexion and internal rotation moments were significantly higher (p<0.01). There were no changes in the knee moments on the non-surgical limb. Medial opening wedge high tibial osteotomy is associated with sustained (12 months) changes in knee moments in all three planes of motion during ambulation, suggesting substantial alterations of the loads on the knee during ambulation.
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Schmitz A, Noehren B. What predicts the first peak of the knee adduction moment? Knee 2014; 21:1077-83. [PMID: 25127390 PMCID: PMC4268356 DOI: 10.1016/j.knee.2014.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/14/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The first peak of the knee adduction moment curve during walking has been shown to be a good clinical surrogate measure of medial tibiofemoral joint loading and osteoarthritis. Defining the relative contributions of the variables that dictate the knee adduction moment, such as center of mass, center of pressure, vertical ground reaction force, and knee adduction angle (i.e. lower limb alignment), has not been formally investigated within the same cohort of individuals. Therefore, the goal of this study was to determine which of these variables is the biggest determinant of the first peak of knee adduction moment curve. METHODS Instrumented gait analysis was collected for 30 individuals. Variables significantly correlated with the peak knee adduction moment were input into a stepwise multi-variable linear regression model. RESULTS The knee adduction angle predicted 58% of the variance in the first peak knee adduction moment and the vertical ground reaction force magnitude predicted the second most variance (20%). CONCLUSIONS The most effective way to modify the peak knee adduction moment may be to change the knee adduction angle (e.g. off loader brace), followed by changing the vertical magnitude of the ground reaction force (e.g. cane use). CLINICAL RELEVANCE Defining the major determinants of the knee adduction moment may help guide clinicians in choosing conservative interventions to reduce it in conditions such as medial tibiofemoral osteoarthritis.
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Affiliation(s)
- Anne Schmitz
- Division of Physical Therapy, University of Kentucky, Lexington, KY, USA
| | - Brian Noehren
- Division of Physical Therapy, University of Kentucky, Lexington, KY, USA.
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Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results. Knee 2014; 21:710-6. [PMID: 24642050 DOI: 10.1016/j.knee.2014.02.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/06/2014] [Accepted: 02/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. METHODS Twenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5weeks (W5) of wearing the brace. VAS-pain, satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phases, step width), and biomechanical data of the ipsilateral lower limb (hip, knee, ankle and foot progression angles) were recorded at each session. RESULTS VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5. CONCLUSION This new knee brace with distraction-rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2 months). LEVEL OF EVIDENCE level IV.
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Caldwell LK, Laubach LL, Barrios JA. Effect of specific gait modifications on medial knee loading, metabolic cost and perception of task difficulty. Clin Biomech (Bristol, Avon) 2013; 28:649-54. [PMID: 23787032 DOI: 10.1016/j.clinbiomech.2013.05.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/06/2013] [Accepted: 05/29/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The metabolic cost and cognitive demand of altering natural gait have not been well studied. The purpose of this investigation was to assess three modified patterns - toe out, ipsilateral trunk lean and a medial weight shift at the foot - on the basis of 1) medial knee joint load reduction, 2) metabolic cost of performance and 3) subject perception of task difficulty. METHODS 12 healthy individuals underwent 3 dimensional motion analysis and metabolic testing to assess the gait mechanics and energy expenditure of natural gait and the three experimental gait patterns, performed to a self-selected moderate degree. Walking speed was controlled. Perceived workload was assessed using the NASA Task Load Index. FINDINGS Trunk lean significantly reduced first peak knee adduction moment (↓32%, P<0.001) as well as KAM impulse (↓35%, P<0.001), but was costly in terms of energy expenditure (↑11%, P<0.001) and perceived workload (↑1178%, P<0.001). A moderate toe-out pattern significantly reduced the second peak knee adduction moment (↓32%, P<0.001) and KAM impulse (↓14%, P=0.026), but had no effect on the first peak. Conversely, toe-out was least demanding in terms of additional energy expenditure (↑2%, P=0.001) and perceived workload (↑314%, P=0.001). Medial shift did not reduce knee adduction moment. INTERPRETATION The prioritization of joint load reduction versus additional metabolic and cognitive demands could play a substantial role in the clinical decision making process of selecting a modified gait pattern.
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Affiliation(s)
- Lydia K Caldwell
- Health and Sport Science, University of Dayton, 300 College Park, Dayton, OH 45469, USA.
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Harris JD, McNeilan R, Siston RA, Flanigan DC. Survival and clinical outcome of isolated high tibial osteotomy and combined biological knee reconstruction. Knee 2013; 20:154-61. [PMID: 23477914 DOI: 10.1016/j.knee.2012.12.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/19/2012] [Accepted: 12/26/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to determine survival and clinical outcomes of high tibial osteotomy (HTO) with or without articular cartilage surgery and/or meniscal allograft transplantation in patients with medial compartment chondral pathology, varus malalignment, and/or meniscal deficiency, whether there is any difference in survival or clinical outcome between these patient cohorts, and whether there is any difference between opening- (OWHTO) and closing-wedge (CWHTO) techniques. METHODS A systematic review of multiple medical databases was performed using PRISMA guidelines. Study quality was assessed via modified Coleman Methodology Scores (MCMS). RESULTS Sixty-nine studies were included (4557 subjects). MCMS rating was overall poor. Mean follow-up was 7.1 years. Mean subject age was 53 years. Survival of isolated HTO was 92.4%, 84.5%, 77.3%, and 72.3% at 5, 10, 15, and 20 years of follow-up. At 5 years of follow-up, HTO with articular cartilage surgery had significantly greater survival (97.7%) than either isolated HTO (92.4%) or HTO with MAT (90.9%). Isolated HTO, HTO with articular cartilage surgery, and HTO with MAT all significantly improved subjective and objective clinical outcome scores. At two years of follow-up, survival was significantly greater following OWHTO (98.7%) versus CWHTO (96.7%). However, at all other time points with or without combined articular cartilage surgery and/or MAT, there was no significant survival difference between the techniques. CONCLUSIONS Survival and clinical outcomes of isolated HTO were excellent at short- and mid-term follow-ups, but deteriorated with time. HTO with concomitant procedures also demonstrated excellent early survival and clinical outcomes that deteriorated with time (up to 10 years).
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Affiliation(s)
- Joshua D Harris
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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Meyer AJ, D'Lima DD, Besier TF, Lloyd DG, Colwell CW, Fregly BJ. Are external knee load and EMG measures accurate indicators of internal knee contact forces during gait? J Orthop Res 2013; 31:921-9. [PMID: 23280647 PMCID: PMC3628973 DOI: 10.1002/jor.22304] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 12/06/2012] [Indexed: 02/04/2023]
Abstract
Mechanical loading is believed to be a critical factor in the development and treatment of knee osteoarthritis. However, the contact forces to which the knee articular surfaces are subjected during daily activities cannot be measured clinically. Thus, the ability to predict internal knee contact forces accurately using external measures (i.e., external knee loads and muscle electromyographic [EMG] signals) would be clinically valuable. We quantified how well external knee load and EMG measures predict internal knee contact forces during gait. A single subject with a force-measuring tibial prosthesis and post-operative valgus alignment performed four gait patterns (normal, medial thrust, walking pole, and trunk sway) to induce a wide range of external and internal knee joint loads. Linear regression analyses were performed to assess how much of the variability in internal contact forces was accounted for by variability in the external measures. Though the different gait patterns successfully induced significant changes in the external and internal quantities, changes in external measures were generally weak indicators of changes in total, medial, and lateral contact force. Our results suggest that when total contact force may be changing, caution should be exercised when inferring changes in knee contact forces based on observed changes in external knee load and EMG measures. Advances in musculoskeletal modeling methods may be needed for accurate estimation of in vivo knee contact forces.
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Affiliation(s)
- Andrew J. Meyer
- Dept. of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL
| | - Darryl D. D'Lima
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA
| | - Thor F. Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - David G. Lloyd
- Griffith Health Institute, Griffith University, Queensland, Australia
| | - Clifford W. Colwell
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA
| | - Benjamin J. Fregly
- Dept. of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL,Dept. of Biomedical Engineering, University of Florida, Gainesville, FL,Dept. of Orthopaedics & Rehabilitation, University of Florida, Gainesville, FL
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Street BD, Gage W. The effects of an adopted narrow gait on the external adduction moment at the knee joint during level walking: evidence of asymmetry. Hum Mov Sci 2013; 32:301-13. [PMID: 23623229 DOI: 10.1016/j.humov.2012.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 08/09/2012] [Accepted: 08/24/2012] [Indexed: 11/16/2022]
Abstract
The external knee adduction moment is an accurate estimation of the load distribution of the knee and is a valid predictor for the presence, severity and progression rate of medial compartment knee osteoarthritis. Gait modification strategies have been shown to be an effective means of reducing the external adduction moment. The purpose of this study was to test narrow gait as a mechanism to reduce the external adduction moment and investigate if limb dominance affects this pattern. Fifteen healthy male participants (mean age: 23.8 (SD=3.1) years, mean height: 1.8 (SD=0.1) m, and mean body mass: 82.9 (SD=16.1 kg) took part in this study. Five walking trials were performed for each of the three different gait conditions: normal gait, toe-out gait, and narrow gait. Adoption of the narrow gait strategy significantly reduced the early stance phase external knee adduction moment compared to normal and toe-out gait (p<.002). However, it was observed that this reduction only occurred in the non-dominant limb. Gait modification can reduce the external knee adduction moment. However, asymmetrical patterns between the dominant and non-dominant limbs, specifically during gait modification, may attenuate the effectiveness of this intervention. The mechanism of limb dominance and the specific roles of each limb during gait may account for an asymmetrical pattern in the moment arm and center of mass displacement during stance. This new insight into how limb-dominance effects gait modification strategies will be useful in the clinical setting when identifying appropriate patients, when indicating a gait modification strategy and in future research methodology.
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Affiliation(s)
- Brian D Street
- Orthopaedic Neuromechanics Laboratory, Sherman Health Science Research Centre, York University, Canada.
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Leitch KM, Birmingham TB, Dunning CE, Robert Giffin J. Changes in valgus and varus alignment neutralize aberrant frontal plane knee moments in patients with unicompartmental knee osteoarthritis. J Biomech 2013; 46:1408-12. [DOI: 10.1016/j.jbiomech.2013.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 01/17/2013] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
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Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM. The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21:96-112. [PMID: 22076053 DOI: 10.1007/s00167-011-1751-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 10/25/2011] [Indexed: 01/10/2023]
Abstract
PURPOSE Both high tibial valgus osteotomy (HTO) and unicompartmental medial knee arthroplasty (UKA) are established methods for the treatment for moderate stages of OA. This is the first global meta-analysis to compare the long-term effects of both methods regarding survival, outcomes and complications of total arthroplasty. METHODS Literature research was performed using established medical databases: MEDLINE (via PubMed), EMBASE (via OVID) and the Cochrane register. Criteria for inclusion were as follows: English or German papers, a clinical trial with a clear description of survival, an outcome evaluation using a well-described knee score and a follow-up >5 years. Statistical analysis was performed using the special meta-analysis software called "Comprehensive Meta Analysis" (version 2.0; Biostat, Englewood, NJ, USA). RESULTS Final meta-analysis after the full-text review included 46 studies about valgus HTO and 43 studies about medial UKA. There were no significant differences between valgus HTO and medial UKA in terms of the number of total required replacements. After a 5- to 8-year follow-up, 91.0% of the valgus HTO patients and 91.5% of medial UKA patients did not need a total replacement. This value was 84.4% for valgus HTOs and 86.9% for medial UKAs after a 9- to 12-year follow-up. Mean survival time to TKA was 9.7 years after valgus HTO and 9.2 years after medial UKA. Clinical outcome was significantly better after medial UKA in a 5- to 12-year follow-up. After more than 12 years, results were comparable in both groups. No significant differences were seen in the complication rates. CONCLUSIONS This meta-analysis aimed to find the advantages and disadvantages of two established methods for the treatment for medial compartment knee osteoarthritis. Valgus HTO is more appropriate for younger patients who accept a slight decrease in their physical activity. Medial UKA is appropriate for older patients obtaining sufficient pain relief but with reduced physical activity. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Gunter Spahn
- Center of Trauma and Orthopaedic Surgery Eisenach, Sophienstr. 16, 99817, Eisenach, Germany.
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Shull PB, Shultz R, Silder A, Dragoo JL, Besier TF, Cutkosky MR, Delp SL. Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis. J Biomech 2013; 46:122-8. [DOI: 10.1016/j.jbiomech.2012.10.019] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 10/18/2012] [Accepted: 10/21/2012] [Indexed: 10/27/2022]
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Gait analysis of walking before and after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21:74-81. [PMID: 21484389 DOI: 10.1007/s00167-011-1496-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Medial opening wedge high tibial osteotomy (HTO) is used to treat medial compartment osteoarthritis (OA) of the knee. HTO shifts the weight-bearing line from the medial compartment into the lateral compartment. The aim of this study was to investigate the functional biomechanical consequences of this alteration in alignment. METHODS Eleven male patients with medial compartment osteoarthritis underwent three-dimensional gait analysis during level walking before 12 months and after medial opening wedge HTO. Nine male control subjects of a similar age were also tested using the same protocol. Sagittal and coronal angles and moments in both operated and non-operated knees were compared. Pre and postoperative radiographic coronal plane alignment was also measured. RESULTS Walking speed increased significantly postoperatively (P = 0.0001) and was not different from controls. Preoperatively, maximum knee flexion in stance was reduced compared to control (P = 0.02). Postoperatively, maximum knee flexion increased significantly (P = 0.005) and was the same as the controls. Similar changes were observed for the maximum knee flexion moment. The mean maximum varus angle during stance was reduced from 13.5° preoperatively to 5.4° postoperatively (P = 0.0001) compared to (6.8°) in controls. The mean maximum adduction moment also reduced from 3.9 to 2.7 (% Bw/ht, P = 0.02), compared to 3.6 in control subjects. Interestingly, the adduction moments in the non-operated knee increased postoperatively from 3.3 to 4.1 (% Bw/ht, P = 0.02). The mean radiological mechanical alignment was changed from 172 degrees preoperatively to 180 degrees postoperatively (P < 0.001). CONCLUSION HTO resulted in normalisation of several dynamic knee function parameters such as walking speed, knee flexion and external knee flexion moment. As anticipated, HTO reduced the varus angle and adduction moments of the operated knee. An increased adduction moment in the non-operated knee over the first postoperative year was found. LEVEL OF EVIDENCE Prospective case-control clinical laboratory study, Level III.
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The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint. PM R 2012; 4:S3-9. [PMID: 22632700 DOI: 10.1016/j.pmrj.2012.01.020] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 11/21/2022]
Abstract
Osteoarthritis (OA) is the most frequent cause of disability in the United States, with the medial compartment of the knee being most commonly affected. The initiation and progression of knee OA is influenced by many factors, including kinematics. In response to loading during weight-bearing activity, cartilage in healthy knees demonstrates spatial adaptations in morphology and mechanical properties. These adaptations allow certain regions of the cartilage to respond to loading; other regions are less well suited to accommodate loading. Alterations in normal knee kinematics shift loading from cartilage regions adapted for loading to regions less well suited for loading, which leads to the initiation and progression of degenerative processes consistent with knee OA. Kinematic variables that are associated with the development, progression, and severity of knee OA are the adduction moment and tibiofemoral rotation. Because of its strong correlation with disease progression and pain, the peak adduction moment during gait has been identified as a target for treatment design. Gait modification offers a noninvasive option for seeking significant reductions. Gait modification has the potential to reduce pain and slow the progression of medial compartment knee OA.
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Foucher KC, Schlink BR, Shakoor N, Wimmer MA. Sagittal plane hip motion reversals during walking are associated with disease severity and poorer function in subjects with hip osteoarthritis. J Biomech 2012; 45:1360-5. [DOI: 10.1016/j.jbiomech.2012.03.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 01/20/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
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Affiliation(s)
- Benjamin J. Fregly
- Department of Mechanical and Aerospace Engineering, University of Florida, 231 MAE-A Building, P.O. Box 116250, Gainesville, FL 32611-6250 USA
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Shull PB, Lurie KL, Cutkosky MR, Besier TF. Training multi-parameter gaits to reduce the knee adduction moment with data-driven models and haptic feedback. J Biomech 2011; 44:1605-9. [PMID: 21459384 DOI: 10.1016/j.jbiomech.2011.03.016] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 03/12/2011] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate gait retraining for reducing the knee adduction moment. Our primary objective was to determine whether subject-specific altered gaits aimed at reducing the knee adduction moment by 30% or more could be identified and adopted in a single session through haptic (touch) feedback training on multiple kinematic gait parameters. Nine healthy subjects performed gait retraining, in which data-driven models specific to each subject were determined through experimental trials and were used to train novel gaits involving a combination of kinematic changes to the tibia angle, foot progression and trunk sway angles. Wearable haptic devices were used on the back, knee and foot for real-time feedback. All subjects were able to adopt altered gaits requiring simultaneous changes to multiple kinematic parameters and reduced their knee adduction moments by 29-48%. Analysis of single parameter gait training showed that moving the knee medially by increasing tibia angle, increasing trunk sway and toeing in all reduced the first peak of the knee adduction moment with tibia angle changes having the most dramatic effect. These results suggest that individualized data-driven gait retraining may be a viable option for reducing the knee adduction moment as a treatment method for early-stage knee osteoarthritis patients with sufficient sensation, endurance and motor learning capabilities.
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Affiliation(s)
- Pete B Shull
- Department of Mechanical Engineering, Stanford University, Center for Design Research, Stanford, CA 94305-2232, USA.
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Wheeler JW, Shull PB, Besier TF. Real-Time Knee Adduction Moment Feedback for Gait Retraining Through Visual and Tactile Displays. J Biomech Eng 2011; 133:041007. [DOI: 10.1115/1.4003621] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The external knee adduction moment (KAM) measured during gait is an indicator of tibiofemoral joint osteoarthritis progression and various strategies have been proposed to lower it. Gait retraining has been shown to be an effective, noninvasive approach for lowering the KAM. We present a new gait retraining approach in which the KAM is fed back to subjects in real-time during ambulation. A study was conducted in which 16 healthy subjects learned to alter gait patterns to lower the KAM through visual or tactile (vibration) feedback. Participants converged on a comfortable gait in just a few minutes by using the feedback to iterate on various kinematic modifications. All subjects adopted altered gait patterns with lower KAM compared with normal ambulation (average reduction of 20.7%). Tactile and visual feedbacks were equally effective for real-time training, although subjects using tactile feedback took longer to converge on an acceptable gait. This study shows that real-time feedback of the KAM can greatly increase the effectiveness and efficiency of subject-specific gait retraining compared with conventional methods.
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Affiliation(s)
- Jason W. Wheeler
- Sandia National Laboratories, P.O. Box 5800, Mail Stop 1010, Albuquerque, NM 87185-1010
| | - Pete B. Shull
- Department of Mechanical Engineering, Stanford University, 424 Panama Mall, Building 560, Stanford, CA 94305-4308
| | - Thor F. Besier
- Department of Orthopaedic Surgery, Stanford University, 341 Galvez Street, Stanford, CA 94305-4308
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Erhart JC, Dyrby CO, D'Lima DD, Colwell CW, Andriacchi TP. Changes in in vivo knee loading with a variable-stiffness intervention shoe correlate with changes in the knee adduction moment. J Orthop Res 2010; 28:1548-53. [PMID: 20973058 PMCID: PMC2965044 DOI: 10.1002/jor.21183] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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 (R(2) = 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.
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Affiliation(s)
- Jennifer C Erhart
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA.
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Erhart JC, Mündermann A, Elspas B, Giori NJ, Andriacchi TP. Changes in knee adduction moment, pain, and functionality with a variable-stiffness walking shoe after 6 months. J Orthop Res 2010; 28:873-9. [PMID: 20058261 DOI: 10.1002/jor.21077] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study tested the effects of variable-stiffness shoes on knee adduction moment, pain, and function in subjects with symptoms of medial compartment knee osteoarthritis over 6 months. Patients were randomly and blindly assigned to a variable-stiffness intervention or constant-stiffness control shoe. The Western Ontario and McMaster Universities (WOMAC) score served as the primary outcome measure. Joint loading, the secondary outcome measure, was assessed using the external knee adduction moment. Peak external knee adduction moment, total WOMAC, and WOMAC pain scores were assessed at baseline and after 6 months. The total WOMAC and WOMAC pain scores for the intervention group were reduced from baseline to 6 months (p = 0.017 and p = 0.002, respectively), with no significant reductions for the control group. There was no difference between groups in magnitude of the reduction in total WOMAC (p = 0.50) or WOMAC pain scores (p = 0.31). The proportion of patients achieving a clinically important improvement in pain was greater in the intervention group than in the control group (p = 0.012). The variable-stiffness shoes reduced the peak knee adduction moment (-6.6% vs. control, p < 0.001) in the 34 intervention subjects at 6 months. The adduction moment reduction significantly improved (p = 0.03) from the baseline reduction. The constant-stiffness control shoe increased the peak knee adduction moment (+6.3% vs. personal, p = 0.004) in the 26 control subjects at 6 months. The results of this study showed that wearing the variable-stiffness shoe lowered the adduction moment, reduced pain, and improved functionality after 6 months of wear. The lower adduction moment associated with wearing this shoe may slow the rate of progression of osteoarthritis after long-term use.
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Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis. Knee 2010; 17:210-6. [PMID: 19896383 DOI: 10.1016/j.knee.2009.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 09/10/2009] [Accepted: 09/26/2009] [Indexed: 02/07/2023]
Abstract
Lower limb dynamic alignment represents the limb position during functional loading conditions and obtains valuable information throughout the gait cycle rather than a single instant in time. This study aims to determine whether dynamic alignment is altered in medial knee osteoarthritis (OA) and how dynamic alignment is related to knee adduction moment (KAM). Community-dwelling women (n=17) with medial OA in at least one knee, according to the American College of Rheumatology criteria and 17 body mass index-matched women without OA were recruited. A three-dimensional motion analysis system was used to collect the gait data at self-selected habitual and maximal speeds. Clinical evaluation of lower extremities, physical function, pain, habitual level of physical activity, quality of life and physical self-efficacy were assessed. Shank adduction angle and shank mean angular velocity were significantly greater in the OA group compared to the controls from heel strike to 30% stance. KAM was not different between the groups (p=0.542). Dynamic alignment variables were the best predictors of KAM. Health-related quality of life, habitual level of physical activity, lower extremity muscle strength and balance performance were impaired in the OA group compared to the controls. The importance of variables that contribute to dynamic alignment and the contribution of limb alignment to KAM were highlighted in this study. Detection of postural changes such as altered dynamic alignment in early stages of OA will lead to the institution of joint-protective measures including changes in footwear, orthotics, gait re-training, use of assistive devices to reduce weight-bearing loads, strengthening and balance enhancing exercises, better analgesia, or cartilage-preserving pharmacotherapy.
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Hunt MA, Birmingham TB, Jones IC, Vandervoort AA, Giffin JR. Effect of tibial re-alignment surgery on single leg standing balance in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2009; 24:693-6. [PMID: 19527918 DOI: 10.1016/j.clinbiomech.2009.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 03/31/2009] [Accepted: 05/11/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standing balance is impaired in individuals with knee osteoarthritis and is associated with disease severity. The effects of surgical interventions on standing balance have received little attention. The purpose of the present study was to examine measures of balance during tests of single-limb standing before and after medial opening wedge high tibial osteotomy--a lower limb re-alignment procedure for those with varus alignment and knee osteoarthritis. METHODS Standing balance was assessed in 49 individuals prior to and 12 months following medial opening wedge high tibial osteotomy. Participants performed three trials of single-limb balance lasting 10s each while standing on a force platform. Anteroposterior and mediolateral coordinates of the centre of pressure were obtained from the force platform and used to calculate the total centre of pressure path length as well as the range and variability (standard deviation) of the anteroposterior and mediolateral coordinates. FINDINGS Though all centre of pressure measures were lower following high tibial osteotomy, none reached statistical significance (P>0.05) and effect sizes were small (d<0.34). The largest mean improvement was 7.6% (95% confidence interval: -0.7-15.8%). INTERPRETATION Results indicate that standing balance in individuals with knee osteoarthritis is not significantly different following high tibial osteotomy surgery. Standing balance in this patient population is a complex process not entirely dictated by disease symptoms or structural factors such as alignment.
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Affiliation(s)
- Michael A Hunt
- Wolf Orthopaedic Biomechanics Laboratory, University of Western Ontario, London, ON, Canada
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Kean CO, Birmingham TB, Garland JS, Jenkyn TR, Ivanova TD, Jones IC, Giffin RJ. Moments and muscle activity after high tibial osteotomy and anterior cruciate ligament reconstruction. Med Sci Sports Exerc 2009; 41:612-9. [PMID: 19204589 DOI: 10.1249/mss.0b013e31818a8c91] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSES To evaluate the effects of simultaneous high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction on 1) the external knee adduction moment, 2) the external knee flexion and extension moments, and 3) the quadriceps, hamstrings, and gastrocnemius muscle activity during walking. METHODS Twenty-one patients with varus malalignment of the lower limb, medial compartment knee osteoarthritis, and concomitant anterior cruciate ligament (ACL) deficiency were tested before and 1 yr after undergoing simultaneous medial opening wedge high tibial osteotomy (HTO) and ACL reconstruction during a single operation. Three-dimensional kinetic and kinematic data were used to calculate external coronal and sagittal moments about the knee. EMG data from the quadriceps, hamstrings, and gastrocnemius were used to determine coactivation ratio and activation patterns. RESULTS Neutral alignment and knee stability were achieved in all patients after surgery. The peak knee adduction moment decreased from 2.88 +/- 0.57 to 1.71 +/- 0.56%BW x Ht (P < 0.001). The early stance knee flexion moment decreased from 1.95 +/- 1.89 to 0.88 +/- 1.17%BW x Ht (P < 0.01). The late stance knee extension moment increased from 1.83 +/- 1.53 to 2.76 +/- 1.22%BW x Ht (P < 0.001). There were no significant differences in muscle coactivation or muscle activation patterns (P > 0.05). CONCLUSIONS Improving lower limb alignment and knee stability significantly alters the coronal and the sagittal moments about the knee during walking, without apparent changes in muscle activation patterns.
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Affiliation(s)
- Crystal O Kean
- Wolf Orthopaedic Biomechanics Laboratory, University of Western Ontario, London, Ontario, Canada
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Birmingham TB, Giffin JR, Chesworth BM, Bryant DM, Litchfield RB, Willits K, Jenkyn TR, Fowler PJ. Medial opening wedge high tibial osteotomy: A prospective cohort study of gait, radiographic, and patient-reported outcomes. ACTA ACUST UNITED AC 2009; 61:648-57. [DOI: 10.1002/art.24466] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Miura H, Takasugi SI, Kawano T, Manabe T, Iwamoto Y. Varus-valgus laxity correlates with pain in osteoarthritis of the knee. Knee 2009; 16:30-2. [PMID: 18954990 DOI: 10.1016/j.knee.2008.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 08/23/2008] [Accepted: 09/14/2008] [Indexed: 02/02/2023]
Abstract
Pain during osteoarthritis (OA) of the knee does not necessarily correlate with the severity of the radiographic grade, and the mechanism of pain has not been completely clarified. The purpose of this study was to evaluate risk factors for pain in the knee OA using epidemiologic analyses. We evaluated 518 out of 4183 people over the age of 40 (156 males and 362 females) from Shinyoshitomi village, Japan. Mean ages were 63.8 years for men and 60.7 years for women. Screening included a physical examination of the knee and a standing AP roentgenogram of the bilateral knee. Radiographic OA was defined as a Kellgren-Lawrence grade 2 or higher. All data were coded and pain risk factors were evaluated using a multiple logistic regression model. Radiographic OA was observed in 18.4% of men and 26% of women. Of these subjects with OA, 10.9% of men and 32.5% of women complained of knee pain. Seven factors-age, gender, BMI, radiographic grade, varus-valgus laxity, torque of quadriceps muscles, and varus-valgus alignment-were evaluated as potential risk factors for pain. A significant increase in the odds ratio was observed with varus-valgus laxity (p=0.005; odds ratio, 3.04). Our results suggest that varus-valgus laxity is a risk factor for pain during knee OA.
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Affiliation(s)
- Hiromasa Miura
- Department of Rehabilitation Medicine, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan.
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37
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A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis. J Biomech 2008; 41:2720-5. [PMID: 18675981 DOI: 10.1016/j.jbiomech.2008.06.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 05/07/2008] [Accepted: 06/06/2008] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate the effectiveness of variable-stiffness shoes in lowering the peak external knee adduction moment during walking in subjects with symptomatic medial compartment knee osteoarthritis. The influence on other lower extremity joints was also investigated. The following hypotheses were tested: (1) variable-stiffness shoes will lower the knee adduction moment in the symptomatic knee compared to control shoes; (2) reductions in knee adduction moment will be greater at faster speeds; (3) subjects with higher initial knee adduction moments in control shoes will have greater reductions in knee adduction moment with the intervention shoes; and (4) variable-stiffness shoes will cause secondary changes in the hip and ankle frontal plane moments. Seventy-nine individuals were tested at self-selected slow, normal, and fast speeds with a constant-stiffness control shoe and a variable-stiffness intervention shoe. Peak moments for each condition were assessed using a motion capture system and force plate. The intervention shoes reduced the peak knee adduction moment compared to control at all walking speeds, and reductions increased with increasing walking speed. The magnitude of the knee adduction moment prior to intervention explained only 11.9% of the variance in the absolute change in maximum knee adduction moment. Secondary changes in frontal plane moments showed primarily reductions in other lower extremity joints. This study showed that the variable-stiffness shoe reduced the knee adduction moment in subjects with medial compartment knee osteoarthritis without the discomfort of a fixed wedge or overloading other joints, and thus can potentially slow the progression of knee osteoarthritis.
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Upper tibia osteotomy: long term results - realignment analysis using OASIS computer software. J Orthop Sci 2008; 13:328-34. [PMID: 18696191 DOI: 10.1007/s00776-008-1234-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 03/24/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The normal values for axial alignment and joint line obliquity of the knee that indicate a successful valgus upper tibial osteotomy have not been established and reported in the literature. METHODS To identify those parameters we prospectively followed 51 patients with 54 lateral closing wedge upper tibial osteotomies performed after preoperative and postoperative analysis of standardized hip-to-ankle radiographs with a software computer program (OASIS). RESULTS Of the 54 knees, 18 (33.3%) underwent additional surgery. The average follow-up of the remaining 36 knees was 10 years (range 6.9-13.8 years). The cumulative osteotomy survival rate was 89% at 5 years and 76% at 10 years. Compared with patients whose postoperative femorotibial angle was 174 degrees -180 degrees , the patients whose postoperative femorotibial angle was <174 degrees or >180 degrees did worse with respect to osteotomy failure. Ten knees were at a decreased risk of failure. These knees had a postoperative femorotibial angle of 174 degrees -180 degrees , lateral joint line obliquity of <4 degrees , and a medial plateau force distribution of 40%-60%. The knees that met these criteria had 100% survival at 5 and 10 years, whereas the rest of the knees had survival rates of 86% and 70%, respectively. CONCLUSIONS We believe that using these criteria during preoperative planning may improve the survival of upper tibial osteotomy provided a precise, reproducible surgical technique and rigid fixation can be performed.
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Lynn SK, Costigan PA. Effect of foot rotation on knee kinetics and hamstring activation in older adults with and without signs of knee osteoarthritis. Clin Biomech (Bristol, Avon) 2008; 23:779-86. [PMID: 18343001 DOI: 10.1016/j.clinbiomech.2008.01.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 01/16/2008] [Accepted: 01/21/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND To determine the effects of changing the natural foot progression angle during gait (internal and external foot rotation) on the knee's adduction moment, lateral-medial shear force, and the ratio of medial-lateral hamstring muscle activation in those with signs of knee osteoarthritis and a matched healthy control group. METHODS Twelve subjects with signs of knee osteoarthritis and 12 matched healthy control subjects were evaluated. A 3D gait analysis system calculated forces and moments at the knee while the subjects walked in three conditions: (1) normal foot position, (2) external foot rotation, (3) internal foot rotation. Medial and lateral hamstring EMG data was also collected simultaneously and used to calculate the medial-lateral hamstring activation ratio during the stance phase of the gait cycle. Repeated measures ANOVAs were used to compare foot rotation conditions within each group; while between group comparisons were performed in the normal rotation condition only using t-tests. FINDINGS Those with knee osteoarthritis (OA) had an increased late stance knee adduction moment and a decreased medial-lateral hamstring activation ratio as compared to the healthy control group. Also, external foot rotation decreased the late stance knee adduction moment, lateral-medial shear force, and hamstring activation ratio. However, internal foot rotation did not increase these measures. INTERPRETATION Changes in foot position during gait have the ability to alter both the external loading of the knee joint and hamstring muscle activation patterns during gait. This may have implication in helping to unload the knee's articular cartilage.
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Affiliation(s)
- Scott K Lynn
- School of Kinesiology and Health Studies, Queen's University, PEC, 69 Union St, Kingston, Ontario, Canada K7L 3N6
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Hunt MA, Birmingham TB, Bryant D, Jones I, Giffin JR, Jenkyn TR, Vandervoort AA. Lateral trunk lean explains variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis. Osteoarthritis Cartilage 2008; 16:591-9. [PMID: 18206395 DOI: 10.1016/j.joca.2007.10.017] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 10/29/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test the hypothesis that selected gait kinematics, particularly lateral trunk lean, observed in patients with medial compartment knee osteoarthritis explain variation in dynamic knee joint load. METHOD In this cross-sectional observational study, 120 patients with radiographically confirmed varus gonarthrosis underwent three-dimensional gait analysis at their typical walking speed. We used sequential (hierarchical) linear regression to examine the amount of variance in dynamic knee joint load (external knee adduction moment) explained by static lower limb alignment (mechanical axis angle) and gait kinematics determined a priori based on their proposed effect on knee load (walking speed, toe-out angle, and lateral trunk lean angle). RESULTS Approximately 50% of the variation in the first peak external knee adduction moment was explained by mechanical axis angle (25%), Western Ontario and McMaster Universities Osteoarthritis Index pain score (1%), gait speed (1%), toe-out angle (12%), and lateral trunk lean angle (13%). There was no confounding or interaction with Kellgren and Lawrence grade of severity. CONCLUSIONS Gait kinematics, particularly lateral trunk lean, explain substantial variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis. While largely ignored in previous gait studies, the effect of lateral trunk lean should be considered in future research evaluating risk factors and interventions for progression of knee osteoarthritis.
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Affiliation(s)
- M A Hunt
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
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Arthur A, LaPrade RF, Agel J. Proximal tibial opening wedge osteotomy as the initial treatment for chronic posterolateral corner deficiency in the varus knee: a prospective clinical study. Am J Sports Med 2007; 35:1844-50. [PMID: 17724096 DOI: 10.1177/0363546507304717] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nonoperative treatment of posterolateral knee injuries tends to yield poor results. In patients with chronic posterolateral knee injuries, failure to correct genu varus alignment will often result in failure of the posterolateral knee repair or reconstruction. PURPOSE To prospectively assess the functional outcomes of patients with combined grade 3 posterolateral instability and genu varus alignment initially treated with a proximal tibial opening wedge osteotomy. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS Twenty-one patients with combined chronic posterolateral corner deficiency and genu varus alignment were initially treated with a proximal tibial opening wedge osteotomy and observed prospectively. Second-stage ligamentous reconstruction was performed in patients with continued clinical and functional instability after the osteotomies had healed and they had undergone at least 3 months of rehabilitation. RESULTS At a mean follow-up of 37 months, 8 of 21 patients (38%) had sufficient improvement in knee function that a subsequent posterolateral corner reconstruction was not necessary. There was a significant difference in coronal alignment between the preoperative and postoperative mechanical axis action point. There were no significant differences in the preoperative and postoperative posterior tibial slope. Thirteen patients underwent a second-stage ligament reconstruction at an average of 13.8 months after the initial osteotomy procedure. Final postoperative Cincinnati Knee Rating System scores were significantly lower for those patients who required a subsequent posterolateral corner reconstruction than for those patients who did not have a reconstruction. The P value for the preoperative differences between groups was not significant (P = .11). Seven of 9 patients with high-velocity knee injuries required a second-stage reconstruction. Ten of 14 patients (71%) with multiligament knee injuries required a posterolateral corner reconstruction. In contrast, 4 of 6 patients (67%) with an isolated posterolateral corner injury did not require a second-stage ligament reconstruction. CONCLUSION Proximal tibial opening wedge osteotomy can be an effective first method of treatment for patients with chronic combined posterolateral knee injuries and genu varus alignment. Patients with low-velocity knee injuries and isolated chronic posterolateral knee injuries may not require a second-stage soft tissue ligament reconstruction after healing the osteotomy and undergoing a program of rehabilitation.
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Affiliation(s)
- Andrew Arthur
- Sports Medicine and Shoulder Division, Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, R200, Minneapolis, MN 55454, USA
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Fregly BJ, Reinbolt JA, Rooney KL, Mitchell KH, Chmielewski TL. Design of patient-specific gait modifications for knee osteoarthritis rehabilitation. IEEE Trans Biomed Eng 2007; 54:1687-95. [PMID: 17867361 PMCID: PMC2040055 DOI: 10.1109/tbme.2007.891934] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract-Gait modification is a nonsurgical approach for reducing the external knee adduction torque in patients with knee osteoarthritis (OA). The magnitude of the first adduction torque peak in particular is strongly associated with knee OA progression. While toeing out has been shown to reduce the second peak, no clinically realistic gait modifications have been identified that effectively reduce both peaks simultaneously. This study predicts novel patient-specific gait modifications that achieve this goal without changing the foot path. The modified gait motion was designed for a single patient with knee OA using dynamic optimization of a patient-specific, full-body gait model. The cost function minimized the knee adduction torque subject to constraints limiting how much the new gait motion could deviate from the patient's normal gait motion. The optimizations predicted a "medial-thrust" gait pattern that reduced the first adduction torque peak between 32% and 54% and the second peak between 34% and 56%. The new motion involved three synergistic kinematic changes: slightly decreased pelvis obliquity, slightly increased leg flexion, and slightly increased pelvis axial rotation. After gait retraining, the patient achieved adduction torque reductions of 39% to 50% in the first peak and 37% to 55% in the second one. These reductions are comparable to those reported after high tibial osteotomy surgery. The associated kinematic changes were consistent with the predictions except for pelvis obliquity, which showed little change. This study demonstrates that it is feasible to design novel patient-specific gait modifications with potential clinical benefit using dynamic optimization of patient-specific, full-body gait models. Further investigation is needed to assess the extent to which similar gait modifications may be effective for other patients with knee OA.
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Affiliation(s)
| | - Jeffrey A. Reinbolt
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL 32611 USA, Department of Bioengineering, Stanford University, Stanford, CA 94305 USA (e-mail: )
| | - Kelly L. Rooney
- Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611 USA
| | | | - Terese L. Chmielewski
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611 USA (e-mail: )
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Guo M, Axe MJ, Manal K. The influence of foot progression angle on the knee adduction moment during walking and stair climbing in pain free individuals with knee osteoarthritis. Gait Posture 2007; 26:436-41. [PMID: 17134902 DOI: 10.1016/j.gaitpost.2006.10.008] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 10/26/2006] [Accepted: 10/29/2006] [Indexed: 02/02/2023]
Abstract
The external knee adduction moment during walking and stair climbing has a characteristic double hump pattern. The magnitude of the adduction moment is associated with the development and progression of medial compartment knee osteoarthritis (OA). There is an inverse relationship between the magnitude of the second peak adduction moment and foot progression angle (FPA). Increasing FPA beyond a self-selected degree of toe-out may further reduce the magnitude of this moment for persons with knee OA. In this study, subjects with medial compartment knee OA walked and climbed stairs using their natural (i.e. self-selected) and an increased FPA (i.e. self-selected+15 degrees of additional toe-out). Increasing FPA did not change the magnitude of the first peak adduction moment but it did significantly decrease the second peak during walking. The first peak moment during stair ascent was significantly greater for the increased FPA condition, and a significant reduction was noted for the second peak. No significant differences were noted during stair descent. These results suggest that walking with a toe-out strategy may benefit persons with early stages of medial knee OA.
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Affiliation(s)
- Mengtao Guo
- Center for Biomedical Engineering Research, Department of Mechanical Engineering, University of Delaware, Newark, DE 19716, United States
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Kuroyanagi Y, Nagura T, Matsumoto H, Otani T, Suda Y, Nakamura T, Toyama Y. The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis. Osteoarthritis Cartilage 2007; 15:932-6. [PMID: 17391994 DOI: 10.1016/j.joca.2007.02.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 02/04/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Two lateral wedged insoles were compared: one with, and the other without, subtalar strapping. METHODS Twenty-one patients (age 58-83, mean 72) with medial knee osteoarthritis (OA) were enrolled. Thirty-seven knees in the patients were divided into three groups based on the Kellgren and Lawrence OA grading system; grades 2 (cases=20), 3 (cases=11), and 4 (cases=6). The subjects were tested during walking barefoot and during walking with a silicon rubber lateral wedged insole with elevation of 10 mm attached to a barefoot. Gait analysis was performed on a 10 m walkway for each subject under three different walking conditions; barefoot, wearing a conventional insole, and a subtalar strapping insole. Peak knee varus moment during gait was measured under each condition, and compared between the three conditions and between the OA grades. RESULTS On the whole (cases=37), the peak varus moment was significantly reduced by wearing either of the insoles, compared to walking barefoot. The reduction was more obvious with the strapping insole (-13%, P<0.01), compared with the conventional insole (-8%, P<0.05). In moderate OA patients (grades 2 and 3), the moments were significantly lower with the strapping insole, compared with the conventional insole (P=0.0048 and 0.005, respectively). However, no significant difference was detected in severe OA patients (grade 4) between the two types of insoles (P=0.4). CONCLUSIONS Both lateral wedged insoles significantly reduced the peak medial compartment load during gait. The subtalar strapping insole had a greater effect than the conventional insole, particularly in patients with moderate medial knee OA.
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Affiliation(s)
- Y Kuroyanagi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
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Reinbolt JA, Haftka RT, Chmielewski TL, Fregly BJ. A computational framework to predict post-treatment outcome for gait-related disorders. Med Eng Phys 2007; 30:434-43. [PMID: 17616425 DOI: 10.1016/j.medengphy.2007.05.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 05/09/2007] [Accepted: 05/09/2007] [Indexed: 10/23/2022]
Abstract
Clinicians often use intuitive models based on clinical experience or regression models based on population studies to plan treatment of gait-related disorders. Because such models are constructed using data collected from previous patients, the predicted clinical outcome for a particular patient may not be reliable. We propose a new approach that uses computational models based on engineering mechanics to predict post-treatment outcome from pre-treatment movement data. The approach utilizes a four-phase optimization process built around a dynamic, patient-specific gait model. The first three phases calibrate the model's joint, inertial, and control parameters, respectively, where the control parameters are weights in an optimization cost function that tracks the patient's pre-treatment gait motion and loads. The last phase predicts the patient's post-treatment gait pattern by performing a tracking optimization with the calibrated model modified to simulate the selected treatment. We demonstrate the approach by simulating how two treatments for knee osteoarthritis (OA)--gait modification and high tibial osteotomy (HTO) surgery--alter the external knee adduction torque for a specific patient. By performing multiple tracking optimizations, we calibrated the model's parameter values to reproduce the patient's knee adduction torque curve for a toe out gait motion. When we performed a tracking optimization with the calibrated model using a modified footpath to simulate an increased stance width, the predicted reduction in both adduction torque peaks matched experimental results to within 4.8% error. When we performed a tracking optimization with the same model using modified leg geometry to simulate HTO surgery, the predicted reductions were consistent with published data. The approach requires further evaluation with a larger number of patients to determine its effectiveness for planning the treatment of gait-related disorders on a patient-specific basis.
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Affiliation(s)
- Jeffrey A Reinbolt
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA
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Gaasbeek RDA, Groen BE, Hampsink B, van Heerwaarden RJ, Duysens J. Valgus bracing in patients with medial compartment osteoarthritis of the knee. A gait analysis study of a new brace. Gait Posture 2007; 26:3-10. [PMID: 16962329 DOI: 10.1016/j.gaitpost.2006.07.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 07/05/2006] [Accepted: 07/08/2006] [Indexed: 02/02/2023]
Abstract
A new valgus brace was evaluated in 15 patients with medial osteoarthritis of the knee and a varus leg axis. Significant improvement of pain and function were found after 6 weeks of brace treatment. Gait analysis showed that the brace had a tendency of lowering the peak varus moment about the knee. This effect was more profound in the presence of higher initial varus deformity angle of the knee. Furthermore, bracing led to a small decrease of knee extension at the end of the swing phase and an increase of walking velocity. The mechanisms identified by gait analysis in this study may be of clinical importance for future developments in brace treatment.
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Affiliation(s)
- Robert D A Gaasbeek
- Limb Deformity Reconstruction Unit, Department of Orthopaedic Surgery, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
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Fisher DS, Dyrby CO, Mündermann A, Morag E, Andriacchi TP. 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. J Orthop Res 2007; 25:540-6. [PMID: 17205556 DOI: 10.1002/jor.20157] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- David S Fisher
- Department of Mechanical Engineering, Stanford University, 496 Lomita Mall-BME, Durand Building 061, Stanford, California 94305-4038, USA.
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Abstract
High tibial osteotomy is a well-established procedure for the management of medial compartment arthritis that is currently experiencing a resurgence in popularity. A number of techniques have been described, with the ultimate goal of obtaining appropriate alignment to provide pain relief and functional improvement over a long-term period. Appropriate patient selection and careful surgical technique is necessary to achieve these goals with a minimal risk of complication. Newer technology such as computer navigation promises to improve the overall accuracy of the procedure. The need for alignment correction in combination with ligament reconstruction and chondral resurfacing surgery will increase the indications for this procedure. This article discusses the techniques available for high tibial osteotomy, the results and relative advantages of each, and the appropriate surgical technique to achieve optimal results while minimizing complications.
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Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Giffin JR. Test–retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis. ACTA ACUST UNITED AC 2007; 57:1012-7. [PMID: 17665490 DOI: 10.1002/art.22899] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the test-retest reliability of the peak external knee adduction moment during walking in patients with medial compartment knee osteoarthritis (OA), and to describe the interpretation of the reported values. METHODS A total of 31 patients diagnosed with knee OA confined primarily to the medial compartment underwent quantitative gait analyses during 2 separate test sessions at least 24 hours apart and within 1 week. The peak knee adduction moment was calculated for each patient at each session based on the mean of 5 walking trials. Reliability was estimated using the intraclass correlation coefficient (ICC(2,1)) and the standard error of measurement (SEM). RESULTS The mean difference in peak adduction moments between test sessions was 0.1% body weight x height (BW x ht; 95% confidence interval [95% CI] -0.1, 0.3). The point estimate for the ICC was 0.86 (95% CI 0.73, 0.96). The point estimate for the SEM was 0.36% BW x ht (95% CI 0.29, 0.48). CONCLUSION The ICC suggests that the peak knee adduction moment is appropriate for use when distinguishing among patients, for example, in studies of various interventions intended to decrease dynamic load on the knee medial compartment. The SEM illustrates the importance of considering measurement error and incorporating confidence levels when interpreting an individual patient's peak knee adduction moment value.
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Affiliation(s)
- Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
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Shimada S, Kobayashi S, Wada M, Uchida K, Sasaki S, Kawahara H, Yayama T, Kitade I, Kamei K, Kubota M, Baba H. Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis. Arch Phys Med Rehabil 2006; 87:1436-41. [PMID: 17084116 DOI: 10.1016/j.apmr.2006.08.018] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 02/21/2006] [Accepted: 08/01/2006] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine the effects of lateral wedged insoles on knee kinetics and kinematics during walking, according to radiographic severity of medial compartment knee osteoarthritis (OA). DESIGN A prospective case control study of patients with medial compartment OA of the knee. SETTING Gait analysis laboratory in a university hospital. PARTICIPANTS Forty-six medial compartment knees with OA of 23 patients with bilateral disease and 38 knees of 19 age-matched healthy subjects as controls. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We measured the peak external adduction moment at the knee during the stance phase of gait and the first acceleration peak after heel strike at the lateral side of the femoral condyles. Kellgren and Lawrence grading system was used for radiographic assessment of OA severity. RESULTS The mean value of peak external adduction moment of the knee was higher in OA knees than the control. Application of lateral wedged insoles significantly reduced the peak external adduction moment in Kellgren-Lawrence grades I and II knee OA patients. The first acceleration peak value after heel strike in these patients was relatively high compared with the control. Application of lateral wedged insoles significantly reduced the first acceleration peak in Kellgren-Lawrence grades I and II knee OA patients. CONCLUSIONS The kinetic and kinematic effects of wearing of lateral wedged insoles were significant in Kellgren-Lawrence grades I and II knee OA. The results support the recommendation of use of lateral wedged insoles for patients with early and mild knee OA.
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Affiliation(s)
- Seiichiro Shimada
- Gait Analysis Laboratory, Division of Physical Therapy and Rehabilitation, Fukui University Hospital, Fukui, Japan.
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