Search

OBJECTIVE:To determine if clinical correlates of knee osteoarthritis(OA) affect likelihood of outcome to intra-articular steroid injections(IASI) in symptomatic knee OA. METHODS:Men and women aged≥40 years with painful knee OA who participated in an open label trial of IASI completed questionnaires and clinical examination. OMERACT-OARSI criteria were used to assess response to therapy in the short-term(within 2-weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline KOOS-pain score at 6-months were characterised as longer-term responders. Log binomial regression was used to examine factors associated with outcome. RESULTS:199 participants were included, of whom 146(73.4%) were short-term and 40(20.1%) longer-term responders. Compared to short-term non-responders, participants with medial joint-line tenderness(RR=1.42;1.10-1.82), medial & lateral joint-line tenderness(RR=1.38;1.03-1.84), patellofemoral tenderness(RR=1.27;1.04-1.55), anserine tenderness(RR=1.27;1.06-1.52) and a belief that treatment would be effective(RR/unit increase, [range 0-10]=1.05;1.01-1.09), were more likely to be short-term responders. Aspiration of joint fluid(RR=0.79;0.66-0.95) and previous ligament/meniscus injury(RR=0.63;0.44-0.91) were associated with a reduced risk of being a short-term responder. Compared to initial non-responders and those whose pain recurred within 6-months, participants with higher number of pain sites(RR/unit increase, [range 0-10]=0.83;0.72-0.97), chronic widespread pain(RR=0.32;0.10-0.98), perceived chronicity of disease(RR/unit increase, [range 0-10]=0.86;0.78-0.94) and a higher depression score(RR/unit increase, [range 0-21]=0.89;0.81-0.99) were less likely to be longer-term responders. CONCLUSION:Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome to IASI. However, clinical-related factors did not predict longer-term response while those with chro

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

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

Background. Few if any prevention strategies are available for knee osteoarthritis (OA). In those with symptomatic medial OA, the contralateral knee may be at high risk of disease and a reduction in medial loading in that knee might prevent disease or its progression there. Lateral wedge insoles reduce loading across an affected medial knee but their effect on the contralateral knee is unknown. Methods: To determine the proportion of persons with medial knee OA who had concurrent medial contralateral OA or developed contralateral medial OA later, we examined knee radiographs from the longitudinal Framingham Osteoarthritis Study. Then, to examine an approach to reducing medial load in the contralateral knee, 51 people from a separate study with painful medial tibiofemoral OA underwent gait analysis wearing bilateral controlled shoes with i) no insoles ii) two types of lateral wedge insoles laterally posted by 5 degrees. Primary outcome was the external knee adduction moment (EKAM) in the contralateral knee. Non-parametric confidence intervals were constructed around the median differences in percentage change in the affected and contralateral sides. Results: Of Framingham subjects with medial radiograph knee OA, 137/152 (90%) either had concurrent contralateral medial OA or developed it within 10 years. 43/67 (64%) of those with medial symptomatic knee OA had or developed the same disease state in the contralateral knee. Compared to a control shoe, medial loading was reduced substantially on both the affected (median percentage EKAM change =-4.84%; 95% CI -11.33% to -0.65%) and contralateral sides (median EKAM percentage change -9.34% (95% CI -10.57% to -6.45%). Conclusions: In persons with medial OA, the contralateral knee is also at high risk of medial OA. Bilateral reduction in medial loading in knees by use of strategies such as lateral wedge insoles might not only reduce medial load in affected knees but prevent knee OA or its progression on the contralateral si