Several biomechanics treatments for knee osteoarthritis (OA) have emerged with the goal of reducing pain and improving function. Through this, researchers have hoped to achieve a transition from the pathological gait patterns to coordinated motor responses. The purpose of the study was to determine the long-term effects of a therapy using a biomechanical device in patients with knee OA. Patients with knee OA were enrolled to active and control groups. The biomechanical device used in therapy (AposTherapy) was individually calibrated to each patient in the active group. Patients in the control group received standard treatment. Outcomes were the Western Ontario and McMaster Osteoarthritis Index (WOMAC), Aggregated Locomotor Function (ALF), Short Form 36 (SF-36), and Knee Society Score assessments. The active and control groups were similar at the baseline (group difference in all scores ). The active group showed a larger improvement over time between groups in all three WOMAC categories ( , 21.7, and 18.1 for pain, stiffness, and function; all ), SF-36 Physical Scale ( ; ), Knee Society Knee Score ( ; ), and Knee Society Function Score ( ; ). At the two-year endpoint, the active group showed significantly better results (all ). The groups showed a difference of 4.9, 5.6, and 4.7 for the WOMAC pain, stiffness, and function scores, respectively, 10.8 s in ALF score, 30.5 in SF-36 Physical Scale, 16.9 in SF-36 Mental Scale, 17.8 in Knee Society Knee Score, and 25.2 in Knee Society Function Score. The biomechanical therapy examined was shown to significantly reduce pain and improve function and quality of life of patients with knee OA over the long term. 1. Introduction Knee osteoarthritis (OA) is one of the leading causes of disability in the elderly [1]. Currently, there is no cure for knee OA, and therefore, the primary goal of treatment is to reduce pain and improve function [2]. In recent years, there has been growing evidence on the importance of biomechanical factors in knee OA. Several biomechanical treatments for knee OA have emerged with the goal of reducing pain and improving function. These treatments aim to unload the diseased articular surface by using wedged insoles, foot orthoses, or valgus braces [3–5]. Other treatments have instead aimed to modify neuromuscular patterns, with a specific goal of improving gait patterns. The knee adduction moment (KAM) is an important parameter of gait that has been examined in recent years. A varus alignment of the femur and tibia compresses the medial compartment of the knee [6]. KAM results from the
References
[1]
R. C. Lawrence, C. G. Helmick, F. C. Arnett, et al., “Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States,” Arthritis & Rheumatism, vol. 41, no. 5, pp. 778–799, 1998.
[2]
C. F. Dillon, E. K. Rasch, Q. Gu, and R. Hirsch, “Prevalence of knee osteoarthritis in the United States: Arthritis data from the Third National Health and Nutrition Examination Survey 1991–94,” Journal of Rheumatology, vol. 33, no. 11, pp. 2271–2279, 2006.
[3]
R. W. Brouwer, T. S. Jakma, A. P. Verhagen, J. A. Verhaar, and S. M. Bierma-Zeinstra, “Braces and orthoses for treating osteoarthritis of the knee,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD004020, 2005.
[4]
M. R. Maly, E. G. Culham, and P. A. Costigan, “Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis,” Clinical Biomechanics, vol. 17, no. 8, pp. 603–610, 2002.
[5]
F. E. Pollo, “Bracing and heel wedging for unicompartmental osteoarthritis of the knee,” The American Journal of Knee Surgery, vol. 11, no. 1, pp. 47–50, 1998.
[6]
T. P. Andriacchi, A. Mündermann, R. L. Smith, E. J. Alexander, C. O. Dyrby, and S. Koo, “A framework for the in vivo pathomechanics of osteoarthritis at the knee,” Annals of Biomedical Engineering, vol. 32, no. 3, pp. 447–457, 2004.
[7]
T. P. Andriacchi, “Dynamics of knee malalignment,” Orthopedic Clinics of North America, vol. 25, no. 3, pp. 395–403, 1994.
[8]
T. P. Andriacchi, T. S. Stanwyck, and J. O. Galante, “Knee biomechanics and total knee replacement,” Journal of Arthroplasty, vol. 1, no. 3, pp. 211–219, 1986.
[9]
A. J. Baliunas, D. E. Hurwitz, A. B. Ryals et al., “Increased knee joint loads during walking are present in subjects with knee osteoarthritis,” Osteoarthritis and Cartilage, vol. 10, no. 7, pp. 573–579, 2002.
[10]
T. Miyazaki, M. Wada, H. Kawahara, M. Sato, H. Baba, and S. Shimada, “Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis,” Annals of the Rheumatic Diseases, vol. 61, no. 7, pp. 617–622, 2002.
[11]
G. K. Fitzgerald, J. D. Childs, T. M. Ridge, and J. J. Irrgang, “Agility and perturbation training for a physically active individual with knee osteoarthritis,” Physical Therapy, vol. 82, no. 4, pp. 372–382, 2002.
[12]
A. Shumway-Cook, Motor Control: Translating Research into Clinical Practice, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 3rd edition, 2007, Edited by A. Shumway-Cook and M. H. Woollacott.
[13]
J. A. Barrios, K. M. Crossley, and I. S. Davis, “Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment,” Journal of Biomechanics, vol. 43, no. 11, pp. 2208–2213, 2010.
[14]
A. Haim, N. Rozen, S. Dekel, N. Halperin, and A. Wolf, “Control of knee coronal plane moment via modulation of center of pressure: a prospective gait analysis study,” Journal of Biomechanics, vol. 41, no. 14, pp. 3010–3016, 2008.
[15]
A. Haim, N. Rozen, and A. Wolf, “The influence of sagittal center of pressure offset on gait kinematics and kinetics,” Journal of Biomechanics, vol. 43, no. 5, pp. 969–977, 2010.
[16]
E. M. Debbi, A. Wolf, and A. Haim, “Detecting and quantifying global instability during a dynamic task using kinetic and kinematic gait parameters,” Journal of Biomechanics, vol. 45, no. 8, pp. 1366–1371, 2012.
[17]
A. Elbaz, A. Mor, G. Segal et al., “APOS therapy improves clinical measurements and gait in patients with knee osteoarthritis,” Clinical Biomechanics, vol. 25, no. 9, pp. 920–925, 2010.
[18]
A. Haim, G. Rubin, N. Rozen, Y. Goryachev, and A. Wolf, “Reduction in knee adduction moment via non-invasive biomechanical training: a longitudinal gait analysis study,” Journal of Biomechanics, vol. 45, no. 1, pp. 41–45, 2012.
[19]
Y. Goryachev, E. M. Debbi, A. Haim, N. Rozen, and A. Wolf, “Foot center of pressure manipulation and gait therapy influence lower limb muscle activation in patients with osteoarthritis of the knee,” Journal of Electromyography and Kinesiology, vol. 21, no. 5, pp. 704–711, 2011.
[20]
Y. Goryachev, E. M. Debbi, A. Haim, and A. Wolf, “The effect of manipulation of the center of pressure of the foot during gait on the activation patterns of the lower limb musculature,” Journal of Electromyography and Kinesiology, vol. 21, no. 2, pp. 333–339, 2011.
[21]
Y. Bar-Ziv, Y. Beer, Y. Ran, S. Benedict, and N. Halperin, “A treatment applying a biomechanical device to the feet of patients with knee osteoarthritis results in reduced pain and improved function: a prospective controlled study,” BMC Musculoskeletal Disorders, vol. 11, article 179, 2010.
[22]
R. Altman, G. Alarcon, D. Appelrouth et al., “The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip,” Arthritis and Rheumatism, vol. 34, no. 5, pp. 505–514, 1991.
[23]
J. H. Kellgren and J. S. Lawrence, “Radiological assessment of osteo-arthrosis,” Annals of the Rheumatic Diseases, vol. 16, no. 4, pp. 494–502, 1957.
[24]
A. Haim, A. Wolf, G. Rubin, Y. Genis, M. Khoury, and N. Rozen, “Effect of center of pressure modulation on knee adduction moment in medial compartment knee osteoarthritis,” Journal of Orthopaedic Research, vol. 29, no. 11, pp. 1668–1674, 2011.
[25]
E. M. Roos, M. Klassbo, and L. S. Lohmander, “WOMAC osteoarthritis index. Reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Western Ontario and MacMaster Universities,” Scandinavian Journal of Rheumatology, vol. 28, no. 4, pp. 210–215, 1999.
[26]
C. J. McCarthy and J. A. Oldham, “The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee,” Rheumatology, vol. 43, no. 4, pp. 514–517, 2004.
[27]
M. Kosinski, S. D. Keller, J. E. Ware Jr., H. T. Hatoum, and S. X. Kong, “The SF-36 health survey as a generic outcome measure in clinical trials of patients with psteoarthritis and rheumatoid arthritis. Relative validity of scales in relation to clinical measures of arthritis severity,” Medical Care, vol. 37, no. 5, pp. MS23–MS39, 1999.
[28]
R. Y. L. Liow, K. Walker, M. A. Wajid, G. Bedi, and C. M. E. Lennox, “The reliability of the American Knee Society Score,” Acta Orthopaedica Scandinavica, vol. 71, no. 6, pp. 603–608, 2000.
[29]
T. Pham, D. van der Heijde, R. D. Altman et al., “OMERACT-OARSI initiative: osteoarthritis research society international set of responder criteria for osteoarthritis clinical trials revisited,” Osteoarthritis and Cartilage, vol. 12, no. 5, pp. 389–399, 2004.
