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Zhang ZQ, Ding YW, Tao Y, Xu HC, Zhong YX, Yang K, Jiang LM. Efficacy of tissue-bone homeostasis manipulation on the gait and knee function for the patients with knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:794. [PMID: 39379908 DOI: 10.1186/s12891-024-07896-y] [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] [Received: 02/01/2024] [Accepted: 09/23/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) was characterized by pain and limited joint function, which seriously affected the quality of life of patients. The vast majority of KOA was closely related to degeneration of the patellofemoral joint and abnormal patellar movement trajectory. Tissue-bone homeostasis manipulation (TBHM) could correct abnormal patellar movement trajectory on the basis of loosening soft tissue. However, there was little strong evidence to verify its efficacy on the patients with KOA. The study objective was to explore the efficacy of the TBHM on gait and knee function in the patients with KOA. METHODS Sixty KOA patients were randomly assigned to either the joint mobilization (n = 30) or TBHM (n = 30) group. The joint mobilization group received joint mobilization, while the TBHM group received TBHM. For two groups, the patients participated in 30 min rehabilitation sessions thrice per week for 12 weeks. The primary outcome was biomechanical gait outcomes during walking, including step length, step velocity, double support, knee range of motion (ROM), and knee adduction moment (KAM). The secondary outcomes were the Western Ontario and McMaster Index (WOMAC) and 36-Item short- form health survey (SF-36), which reflected improvements in knee function and quality of life, respectively. At baseline and 12 weeks, evaluations were conducted and compared between groups. RESULTS After a 12-week intervention, significant group differences were observed in KAM (p = 0.018), WOMAC-Pain (p = 0.043) and WOMAC-Stiffness (p = 0.026). A noteworthy finding was the presence of a significant interaction effect between group and time specifically observed in step velocity during gait (p = 0.046), WOMAC-Function (p = 0.013) and SF-36 (p = 0.027). Further analysis revealed a significant difference in step velocity (p = 0.034), WOMAC-Function (p = 0.025) and SF-36 (p = 0.042) during post-assessment between the two groups. Moreover, a significant time effect was observed across all outcomes of the two groups (p < 0.05). CONCLUSION The TBHM intervention has better improved the gait, knee function, and quality of life in the patients with KOA. TRIAL REGISTRATION ITMCTR, ITMCTR2200005507. Registered 06/01/2022, http://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=09cdadad-0aef-41ee-81bd-a8dceb63f7f5 .
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Affiliation(s)
- Zeng-Qiao Zhang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China
| | - Yu-Wu Ding
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China
| | - Ying Tao
- Shanghai Puxing Community Health-Care Center, Shanghai, 200136, China
| | - Hai-Chen Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China
| | - Ying-Xi Zhong
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China
| | - Kun Yang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China.
| | - Li-Ming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, No.358, Datong Road, Shanghai, 200137, China.
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Falvey KT, Kinshaw CM, Warren GL, Tsai LC. Persistent altered knee loading in patients with meniscectomy: A systematic review and meta-analysis. Phys Ther Sport 2024; 65:14-22. [PMID: 37980779 DOI: 10.1016/j.ptsp.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To determine the changes in knee flexion moment (KFM) and knee adduction moment (KAM) during weight-bearing activities following meniscectomy. DESIGN Meta-Analysis. SETTING Laboratory. PARTICIPANTS 332 meniscectomy patients and 137 healthy controls (from 13 qualified studies) MAIN OUTCOME MEASURES: Cohen's d effect sizes (ESs) were calculated to compare KAM and KFM values of the surgical legs to the non-surgical and to healthy control legs. RESULTS When compared to healthy controls, meniscectomy patients' surgical legs demonstrated a significantly greater KAM (ES = 0.310; P = 0.002) but no significant difference in KFM (ES = -0.182; P = 0.051). When compared to the patients' non-surgical legs, however, the surgical legs showed no difference in KAM (ES = -0.024; P = 0.716) but a significantly lower KFM (ES = -0.422; P < 0.001). High heterogeneity among study ESs was observed in patients' between-limb comparison for KAM (Q-value = 20.08, P = 0.005; I2 = 65.1%) and KFM (Q-value = 43.96, P < 0.001; I2 = 79.5%). However, no significant differences in study ESs (all P > 0.102) of KFM and KAM were identified when comparing studies with various times post-surgery, weight-bearing tasks, walking speeds, or patient demographics. CONCLUSION Elevated KAM and reduced/asymmetrical KFM observed in meniscectomy patients may contribute to the increased risk of knee OA. Rehabilitation should focus on movement education to restore between-limb KFM symmetry and reduce KAM bilaterally post-meniscectomy.
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Affiliation(s)
- Kyle T Falvey
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Chad M Kinshaw
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Gordon L Warren
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA.
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Yang K, Ding Y, Xu H, Lai M, Xu X, Yu X, Deng Q, Jiang L. Efficacy and safety of platelet-rich plasma combined with Tai Chi for knee osteoarthritis: study protocol for a placebo-controlled randomized trial. J Orthop Surg Res 2023; 18:885. [PMID: 37990325 PMCID: PMC10662628 DOI: 10.1186/s13018-023-04372-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND No definitive treatment methods of curative for knee osteoarthritis (KOA). The combined therapies that into account both the biochemical and biomechanical may provide potential opportunities for treat KOA, and previous studies have demonstrated that the platelet-rich plasma of intra-articular injection (IAI-PRP) and exercise treatments afford more benefits than do their corresponding monotherapies. The absence of a specific exercise plan and detailed explanation renders the aforementioned study results questionable. Furthermore, Tai Chi (TC) with moderate-intensity, whole body movements and good adherence may prove to be more effective for treating KOA. However, few studies examined the effectiveness and safety of combined IAI-PRP and TC for KOA. METHODS This study protocol will be a placebo-controlled, assessor-blinded randomized trial involving 12-week intervention and 1-year follow-up. The stratified randomization will be used to randomly assign the 212 participants to four groups: group A (placebo IAI); group B (PRP IAI); group C (TC and placebo IAI); group D (TC and PRP IAI). Injection will be performed once a week, three consecutive times as a course, after a week of rest to continue the next course, a total of 3 courses (12 week). Additionally, the TC interventions will be carried out 3 days per week for a total of 12 weeks. The primary outcome measures will include the efficacy (Western Ontario and McMaster Universities Osteoarthritis Index), acceptability and safety of these interventions. The secondary outcome measures will include physical function (Timed Up and Go test), walking function (Gait Analysis), inflammatory factor levels (e.g., Interleukin-1 β, interleukin-6, vascular endothelial growth factor), quality of life (36-Item Short Form Health Survey), volume of patellofemoral cartilage and effusion-synovitis (MRI). Two-way of variance with repeated measures will be applied to examine the main effects of the group and the time factor and group-time interaction effects for all outcome measures. DISCUSSION This trial will be first one to propose an integrated scheme combing IAI-PRP and TC for treatment of KOA, based on the consideration of the biochemical and biomechanical pathogenesis of KOA. These results of the study will provide evidence with high quality for integrated IAI-PRP and TC to treatment KOA. Trial Registration Chinese Clinical Trial Registry ChiCTR2300067559. Registered on 11 January 2023.
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Affiliation(s)
- Kun Yang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuwu Ding
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haichen Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Minghui Lai
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xueping Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Deng
- School of Health and Nursing, Wuxi Taihu University, Wuxi, China
| | - Liming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Cottmeyer DF, Hoang BH, Lyle MA, Warren GL, Tsai LC. Can exercise interventions reduce external knee adduction moment during gait? A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2023; 109:106064. [PMID: 37672821 DOI: 10.1016/j.clinbiomech.2023.106064] [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] [Received: 01/23/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND An increased external knee adduction moment has been identified as a factor contributing to the progression of medial knee osteoarthritis. Interventions that reduce knee adduction moment may help prevent knee osteoarthritis onset and progression. While exercise interventions have been commonly used to treat knee osteoarthritis, whether exercises can modulate knee adduction moment in knee osteoarthritis patients remains unknown. This systematic review and meta-analysis aimed to determine if exercise interventions are effective in reducing knee adduction moment during gait. METHODS Study reports published through May 2023 were screened for pre-specified inclusion/exclusion criteria. Nine studies met the eligibility criteria and yielded 24 effect sizes comparing the reduction in knee adduction moment of the exercise intervention groups to the control groups. Moderator/experimental variables concerning characteristics of the exercise interventions and included subjects (e.g., sex, BMI, type of exercise, muscle group targeted, training volume, physical therapist supervision) that may contribute to variation among studies were explored through subgroup analysis and meta-regression. FINDINGS The effect of exercise intervention on modulating knee adduction moment during gait was no better than control (ES = -0.004, P = 0.946). Sub-group analysis revealed that the effect sizes of studies containing only females (positive exercise effect) were significantly greater than studies containing both males and females. INTERPRETATION Exercise may not be effective in reducing knee adduction moment during gait. Clinicians aiming to decrease knee adduction moment in patients with medial knee osteoarthritis should consider alternative treatment options. Exploring the underlying mechanism(s) regarding a more positive response to exercises in females may help design more effective exercise interventions.
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Affiliation(s)
- Daniel F Cottmeyer
- Department of Physical Therapy, Georgia State University, 145 Piedmont Ave SE, Atlanta, GA 30303, USA
| | - Brian H Hoang
- Department of Physical Therapy, Georgia State University, 145 Piedmont Ave SE, Atlanta, GA 30303, USA
| | - Mark A Lyle
- Division of Physical Therapy, Emory University, 1462 Clifton Rd, Atlanta, GA 30322, USA
| | - Gordon L Warren
- Department of Physical Therapy, Georgia State University, 145 Piedmont Ave SE, Atlanta, GA 30303, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, 145 Piedmont Ave SE, Atlanta, GA 30303, USA.
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Pathak P, Kim HS, Kim H, Park J, Lee G, Ahn J. Feasibility of mitigating out-toeing gait using compression tights with inward-directing taping lines. PLoS One 2023; 18:e0291914. [PMID: 37733749 PMCID: PMC10513335 DOI: 10.1371/journal.pone.0291914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
Out-toeing gait may cause alterations in lower limb biomechanics that could lead to an increased risk of overuse injuries. Surgery and physical therapy are conventional methods for mitigating such gait, but they are costly and time-consuming. Wearable devices like braces and orthoses are used as affordable alternatives, but they apply non-negligible stress on the skin. Haptic feedback-delivering shoes were also recently developed, but they require actuators and power sources. The purpose of our study is to develop compression tights with inward directing taping lines that apply compression to lower limb muscles and segments to facilitate inward rotation of the foot, overcoming the drawbacks of previous methods. These compression tights were manufactured to fit the average height, leg length, hip girth, and waist girth of South Korean females in their twenties. The efficacy of these compression tights was evaluated by comparing walking kinematics and user satisfaction of 12 female dancers with an out-toeing gait under three conditions: wearing tights with taping lines, tights without taping lines, and basic bicycle shorts. The foot rotation angles and joint kinematics were recorded using a pressure-pad treadmill and motion capture system, respectively. Multiple pairwise comparisons revealed that the compression tights with inward-directing lines significantly reduced foot rotation angles (up to an average of 20.1%) compared with the bicycle shorts (p = 0.002 and 0.001 for dominant and non-dominant foot, respectively) or the compression tights without taping lines (p = 0.005 and p = 0.001 for dominant and non-dominant foot, respectively). Statistical parametric mapping revealed significant main effects of the tight type on joint kinematics. Also, t-tests revealed that the participants reported significantly higher ratings of perceived functionality and usability on the compression tights with inward-directing taping lines. In conclusion, we developed a comfortable and practical apparel-type wearable and demonstrated its short-term efficacy in mitigating out-toeing gait.
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Affiliation(s)
- Prabhat Pathak
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States of America
| | - Hye Suk Kim
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Hyunji Kim
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
| | - Juyeon Park
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
- Department of Fashion and Textiles, Seoul National University, Seoul, Republic of Korea
| | - Giuk Lee
- Department of Mechanical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Jooeun Ahn
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
- Institute of Sport Science, Seoul National University, Seoul, Republic of Korea
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Cagnin A, Choinière M, Bureau NJ, Durand M, Mezghani N, Gaudreault N, Hagemeister N. Targeted exercises can improve biomechanical markers in individuals with knee osteoarthritis: A secondary analysis from a cluster randomized controlled trial. Knee 2023; 40:122-134. [PMID: 36423400 DOI: 10.1016/j.knee.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is not clear whether exercise therapy significantly improves knee biomechanics during gait in osteoarthritis (OA) patients. This study aimed to determine whether targeted exercises based on a knee kinesiography exam improve biomechanical markers (BMs) compared with conventional primary care (CPC) management. METHODS This was a secondary analysis of a cluster randomized controlled trial in which patients were assigned to one of three groups: (1) Control (CPC), (2) Exercise, and (3) Exercise&Education. Fourteen known BMs in knee OA patients were assessed. The primary outcome was the global evolution ratio (GER), which was calculated as the sum of improved BMs over the sum of deteriorated BMs 6 months after baseline assessment. GER scores were categorized with three different sets of cut-off values into clinical levels: (a) Deteriorated, (b) Stabilized, and (c) Improved. Ordinal logistic regressions were performed on the per-protocol population to determine whether there was a relationship between group assignment and GER levels. RESULTS Of the 221 eligible participants, 163 were included. Two different regression models showed that patients from Group 3 (Exercise&Education) were 2.5-times more likely to be in an upper GER level (i.e., Stabilized or Improved) than patients from the control group (both odds ratio (OR) > 2.46, Wald Χ2(1) ≥ 7.268, P ≤ 0.01). They also reported significantly more improvement in pain and function (Knee Injury and Osteoarthritis Outcome Score, both P ≤ 0.01). CONCLUSIONS Results suggest that targeted exercises can improve biomechanical markers in knee OA patients compared with CPC treatment. Further studies are needed to confirm these findings and refine the biomechanical markers to address to maximize patients' clinical outcomes.
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Affiliation(s)
- Alix Cagnin
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Laboratoire de Recherche en Imagerie et Orthopédie de l'École de Technologie Supérieure (ÉTS), Montreal, Quebec, Canada
| | - Manon Choinière
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie J Bureau
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Madeleine Durand
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Neila Mezghani
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université TÉLUQ, #1105, Montreal, Quebec, Canada
| | - Nathaly Gaudreault
- Faculté de Médecine et des Sciences de la Santé, School of Rehabilitation, Sherbrooke Research and Development Centre, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicola Hagemeister
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Laboratoire de Recherche en Imagerie et Orthopédie de l'École de Technologie Supérieure (ÉTS), Montreal, Quebec, Canada.
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Fukaya T, Mutsuzaki H, Mori K. Sway and Acceleration Changes of the Center of Mass during Walking Stance Phase before and after Total Knee Arthroplasty. Geriatrics (Basel) 2022; 8:geriatrics8010002. [PMID: 36648907 PMCID: PMC9844275 DOI: 10.3390/geriatrics8010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Elucidating the sway and changes in the acceleration of center of mass (COM) during walking is important for effective gait training and rehabilitation. The objective of this study was to verify the improvement in gait before and after total knee arthroplasty (TKA) from COM sway and the changes in the acceleration of COM during the stance phase of walking. This study included 13 patients (1 male and 12 females) with medial knee osteoarthritis who were hospitalized for TKA. The COM sway during the stance phase of walking was evaluated using root mean square (RMS) normalized by walking speed, and the changes in acceleration were further verified. Lateral and vertical RMS showed significant differences between preoperative and postoperative states and demonstrated low values after TKA. The lateral acceleration at the latter part of the early stance phase demonstrated a significant difference between preoperative and postoperative states. A significant difference was also observed in the lateral acceleration in the late stance phase between the two groups. Improvement in pain and alignment after TKA reduced the lateral sway of COM and the changes in acceleration during the gait stance phase, which is speculated to lead to improvement in gait and prevention of falls.
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Affiliation(s)
- Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, 6-8-33 Manabe, Tsuchiura 300-0051, Japan
- Correspondence:
| | - Hirotaka Mutsuzaki
- Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Koichi Mori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
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Is Static Alignment a Good Predictor of Dynamic Alignment after Total Knee Arthroplasty? Healthcare (Basel) 2022; 10:healthcare10030418. [PMID: 35326896 PMCID: PMC8956110 DOI: 10.3390/healthcare10030418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/02/2023] Open
Abstract
Background: Total knee arthroplasty (TKA) is the only effective treatment of end-stage knee osteoarthritis (OA). Lower limb neutral alignment has been a criterion to predict prosthesis life; however, there has been recent controversy over this. Some researchers believe that lower limb static alignment does not significantly affect prosthesis life and some researchers have found that dynamic mechanical alignment may affect prosthesis life, which needs to be further studied. Methods: Eighty-seven patients with knee OA were evaluated by a three-dimensional (3D) gait analysis system before TKA and six months after TKA, dynamic mechanical alignment and basic gait parameters were then calculated. Based on the static alignment of the lower limb on the postoperative X-radiographs, they were divided into a neutral alignment group (58 cases), varus alignment group (20 cases), and valgus alignment group (9 cases). Simple linear regression was used to assess the correlation between static and dynamic alignment. One-way analysis of variance (ANOVA) was used to compare the differences in gait parameters between and within groups. Results: Eighty-seven patients were followed up for an average of six months after the operation. There was no significant difference in all gait parameters among the three groups after TKA. There was no correlation found between static alignment and dynamic alignment/knee adduction moment (KAM) after TKA, although patients showed a significant linear correlation before operation. There was a significant linear correlation between dynamic alignment and KAM before and after the operation. Conclusions: Static alignment has no significant effect on postoperative gait function. Static alignment is no longer an effective predictor of the dynamic alignment or KAM six months after TKA, although they are correlated before TKA. The dynamic alignment allows for better prediction of KAM, which may be a risk factor for the life of the prosthesis.
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Tateuchi H. Gait- and postural-alignment-related prognostic factors for hip and knee osteoarthritis: Toward the prevention of osteoarthritis progression. Phys Ther Res 2019; 22:31-37. [PMID: 31289710 DOI: 10.1298/ptr.r0003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Osteoarthritis (OA) is a chronic progressive disease, and thus, prevention of this progression is an important issue. Currently, there is little evidence of the effect of exercise therapy for the prevention of hip and knee OA progression. An understanding of prognostic factors is the basis for the prevention of progression. Previous research indicates that in case of knee OA, abnormalities in knee alignment (varus or valgus) while standing, varus thrust during walking, increased knee flexion in the early stance phase, abnormal displacement of the femur in relation to the tibia, and an increase in knee adduction and flexion moment are risk factors for disease progression. At the same time, the prognostic factors in hip OA are anterior spinal inclination while standing, decreased mobility of the thoracolumbar spine, and increased cumulative hip loading during daily walking. Further research is required to investigate these prognostic factors, particularly the modifiable factors, to analyze the relationships between these factors, and to verify the structural and clinical efficacy of modifying these factors through interventions.
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Affiliation(s)
- Hiroshige Tateuchi
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University
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10
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Parker DA, Scholes C, Neri T. Non-operative treatment options for knee osteoarthritis: current concepts. J ISAKOS 2018. [DOI: 10.1136/jisakos-2016-000094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Arora H. Efficacy of Slow Reversal Hold and Isometrics in Improving Muscle Strength, Increasing Range of Motion, and Reducing Pain in Patients with Osteoarthritis of Knee. Health (London) 2018. [DOI: 10.4236/health.2018.105043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA. Effects of different foot progression angles and platform settings on postural stability and fall risk in healthy and medial knee osteoarthritic adults. Proc Inst Mech Eng H 2017; 232:163-171. [PMID: 29283019 DOI: 10.1177/0954411917750409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study aims to investigate the effects of varying toe angles at different platform settings on Overall Stability Index of postural stability and fall risk using Biodex Balance System in healthy participants and medial knee osteoarthritis patients. Biodex Balance System was employed to measure postural stability and fall risk at different foot progression angles (ranging from -20° to 40°, with 10° increments) on 20 healthy (control group) and 20 knee osteoarthritis patients (osteoarthritis group) randomly (age: 59.50 ± 7.33 years and 61.50 ± 8.63 years; body mass: 69.95 ± 9.86 kg and 70.45 ± 8.80 kg). Platform settings used were (1) static, (2) postural stability dynamic level 8 (PS8), (3) fall risk levels 12 to 8 (FR12) and (4) fall risk levels 8 to 2 (FR8). Data from the tests were analysed using three-way mixed repeated measures analysis of variance. The participant group, platform settings and toe angles all had a significant main effect on balance ( p ≤ 0.02). Platform settings had a significant interaction effect with participant group F(3, 144) = 6.97, p < 0.01 and toe angles F(21, 798) = 2.83, p < 0.01. Non-significant interactions were found for group × toe angles, F(7, 266) = 0.89, p = 0.50, and for group × toe angles × settings, F(21, 798) = 1.07, p = 0.36. The medial knee osteoarthritis group has a poorer postural stability and increased fall risk as compared to the healthy group. Changing platform settings has a more pronounced effect on balance in knee osteoarthritis group than in healthy participants. Changing toe angles produced similar effects in both the participant groups, with decreased stability and increased fall risk at extreme toe-in and toe-out angles.
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Affiliation(s)
- Saad Jawaid Khan
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,2 Department of Biomedical Engineering, Riphah International University, Islamabad, Pakistan
| | - Soobia Saad Khan
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Juliana Usman
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,3 Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdul Halim Mokhtar
- 4 Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noor Azuan Abu Osman
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,3 Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia
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Lateral trunk lean and medializing the knee as gait strategies for knee osteoarthritis. Gait Posture 2017; 51:247-253. [PMID: 27838568 DOI: 10.1016/j.gaitpost.2016.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics. DESIGN Thirty patients with symptomatic medial knee osteoarthritis underwent 3-dimensional gait analysis. Participants received verbal instructions on two gait strategies (Trunk Lean and Medial Thrust) in randomized order after comfortable walking was recorded. The peaks and impulse of the EKAM and strategy-specific kinematic and kinetic variables were calculated for all conditions. RESULTS Early stance EKAM peak was significantly reduced during Medial Thrust (-29%). During Trunk Lean, early and late stance EKAM peak and EKAM impulse reduced significantly (38%, 21% and -25%, respectively). In 79% of the subjects, the Trunk Lean condition was significantly more effective in reducing EKAM peak than Medial Thrust. Peak ankle dorsi and plantar flexion, knee flexion and hip extension and adduction moments were not significantly increased. CONCLUSIONS Medial Thrust and Trunk Lean reduced the EKAM during gait in patients with knee osteoarthritis. Individual selection of the most effective gait modification strategy seems vital to optimally reduce dynamic knee loading during gait. No detrimental effects on external ankle and hip moments or knee flexion moments were found for these conditions.
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Baltzer AWA, Ostapczuk MS, Terheiden HP, Merk HR. Good short- to medium-term results after osteochondral autograft transplantation (OAT) in middle-aged patients with focal, non-traumatic osteochondral lesions of the knee. Orthop Traumatol Surg Res 2016; 102:879-884. [PMID: 27450858 DOI: 10.1016/j.otsr.2016.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/13/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteochondral autograft transplantation (OAT) offers the opportunity to repair cartilaginous defects by restoring hyaline cartilage anatomy. Encouraging results have been reported in patients suffering from acute knee trauma or osteochondritis dissecans. Patients with focal chronic, non-traumatic osteochondral (FCNO) lesions of the knee, however, have rarely been the subject of investigation. Some authors even consider higher age as contraindications to OAT. OBJECTIVES To assess the short- to medium-term outcomes of OAT in middle-aged patients with FCNO lesions of the knee and to identify predictors of clinical outcome. HYPOTHESIS Filling FCNO defects with autologous osteochondral grafts should restore the congruency of the middle-aged knee joint and thereby reduce pain and loss of function on the one hand, and increase quality of life on the other hand. METHODS One hundred and twelve patients (48.01±1.12yrs) with FCNO of the knee were assessed before OAT and 26.2±0.24 months after surgery. Clinical outcome was measured by WOMAC Index and the Visual Analogue Scale (VAS) for pain. RESULTS Pain (pre-OAT VAS vs. post-OAT VAS: 7.14±0.19 vs. 3.74±0.26, P<0.001) was reduced and quality of life (pre-OAT WOMAC vs. post-OAT WOMAC: 134.88±5.84 vs. 65.92±5.34, P<0.001) improved. Retropatellar defects were associated with poor outcome, while overall surface and number of cylinders were not. DISCUSSION Middle-aged patients with FCNO of the knee also profit from OAT at a short follow-up. LEVEL OF EVIDENCE IV. Mono-centric, prospective clinical series.
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Affiliation(s)
- A W A Baltzer
- Associate practice at Königsallee, centre for molecular orthopaedics, Düsseldorf, Germany; University clinic for orthopaedics, Heinrich-Heine university Düsseldorf, Düsseldorf, Germany.
| | - M S Ostapczuk
- Clinic for orthopaedics and trauma surgery, St. Josef Hospital, Moers, Germany; Institute of experimental psychology, Heinrich-Heine university, Düsseldorf, Germany
| | - H P Terheiden
- Clinic for anaesthesiology and intensive care, St. Antonius Hospital, Kleve, Germany
| | - H R Merk
- Clinic and outpatient clinic for orthopaedics and orthopaedic surgery, Ernst-Moritz-Arndt university, Greifswald, Germany
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No effects of a 12-week supervised exercise therapy program on gait in patients with mild to moderate osteoarthritis: a secondary analysis of a randomized trial. J Negat Results Biomed 2015; 14:5. [PMID: 25886499 PMCID: PMC4355150 DOI: 10.1186/s12952-015-0023-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/12/2015] [Indexed: 12/16/2022] Open
Abstract
Background It is unknown whether gait biomechanics in hip osteoarthritis patients with mild to moderate symptoms change following exercise therapy interventions. The aim of the present study was to compare stance phase gait characteristics in hip osteoarthritis patients with mild to moderate symptoms participating in a randomized trial with two different interventions; patient education only or patient education followed by a 12-week supervised exercise therapy program. Results The study was conducted as a secondary analysis of a single-blinded randomized controlled trial. Patients aged 40 to 80 years, with hip osteoarthritis verified from self-reported pain and radiographic changes, were included. The final material comprised 23 patients (10 males/13 females, mean (SD) age 58.2 (10.02) years) in the patient education only group, and 22 patients (9 males/13 females, mean (SD) age 60.2 (9.49) years) in the patient education + exercise therapy group. Three-dimensional gait analysis was conducted at baseline and at four month follow-up. Sagittal and frontal plane joint angle displacement and external joint moments of the hip, knee and ankle were compared from a one-way analysis of covariance between the groups at follow-up, with baseline values as covariates (p < 0.05). No group differences were observed at the four-month follow-up in gait velocity, joint angle displacement, or moments. As the compliance in the exercise therapy group was inadequate, we calculated possible associations between the number of completed exercise sessions and change in each of the kinematic or kinetic variables. Associations were weak to neglible. Thus, the negative findings in this study cannot be explained from inadequate compliance alone, but most likely also suggest the exercise therapy program itself to be insufficient to engender gait alterations. Conclusions Adding a 12-week supervised exercise therapy program to patient education did not induce changes in our selected biomechanical variables during the stance phase of gait, even when adjusting for poor compliance. Thus, we did not find evidence to support our exercise therapy program to be an efficacious intervention to induce gait alterations in this population of hip osteoarthritis patients. Trial registration NCT00319423 at ClinicalTrials.gov (registration date 2006-04-26).
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