Effects of orthotic treatment for medial knee osteoarthritis in Chinese patients: clinical outcome and gait analysis

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Effects of orthotic treatment for medial knee osteoarthritis in Chinese patients: clinical outcome and gait analysis
Key Take-Away: 

Various intra-articular injections, pain killers and surgical methods are being used for the treatment of pain, stiffness and swelling related to medial knee osteoarthritis. In comparison to these painful and adverse effects causing methods, orthotic treatment has emerged as a safe and easy way to provide relief in patient with medial knee osteoarthritis.

To evaluate the effectiveness of various orthotic treatments for patients with isolated medial compartment osteoarthritis.

ABSTRACT: 
Background: 

To evaluate the effectiveness of various orthotic treatments for patients with isolated medial compartment osteoarthritis.

Methods: 

This prospective cohort study with sequential interventions was conducted in University-affiliated hospital, Hong Kong from December 2010 to November 2011.Ten patients with medial knee osteoarthritis were referred by orthopedic surgeons for orthotic treatment.

All patients were sequentially treated with flat insole, lateral wedged insole, lateral wedged insole with subtalar strap, lateral wedged insole with arch support, valgus knee brace, and valgus knee brace with lateral wedged insole with arch support for 4 weeks with no treatment break. Three-dimensional gait analysis and questionnaires were completed after each orthotic treatment. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analogue scale scores, and peak and mean knee adduction moments were the main outcome measures.

Results: 

Compared with pretreatment, the lateral wedged insole, lateral wedged insole with arch support, and valgus knee brace groups demonstrated significant reductions in WOMAC pain score (19.1%, P=0.04; 18.2%, P=0.04; and 20.4%, P=0.02, respectively).

The lateral wedged insole with arch support group showed the greatest reduction in visual analogue scale score compared with pretreatment at 24.1% (P=0.004). The addition of a subtalar strap to lateral wedged insoles (lateral wedged insole with subtalar strap) did not produce significant benefit when compared with the lateral wedged insole alone. The valgus knee brace with lateral wedged insole with arch support group demonstrated an additive effect with a statistically significant reduction in WOMAC total score (-26.7%, P=0.01). Compliance with treatment for the isolated insole groups were all over 90%, but compliance for the valgus knee brace–associated groups was only around 50 percent. Gait analysis indicated statistically significant reductions in peak and mean knee adduction moments in all orthotic groups when compared with a flat insole.

 

Conclusion: 

These results support the use of orthotic treatment for early medial compartment knee osteoarthritis.

 

Hong Kong Med J. 2015 Apr 10; 21(2):98-106

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