Methods to Systematically Change the Patterns of Gait Associated With Osteoarthritis At the Knee

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Abstract

Osteoarthritis, the most common form of arthritis, is a degenerative joint disease, in which mechanical factors play an important role in the initiation and progression. Knee osteoarthritis, in particular, is sensitive to mechanical factors associated with the biomechanics of walking. This suggests the potential for load modifying interventions to slow the rate of progression of knee osteoarthritis. Medial compartment knee osteoarthritis is nearly 10 times more common than lateral compartment osteoarthritis. The discrepancy causing medial compartment knee osteoarthritis to be much more common is theorized to be the result of an increased load on the medial knee compartment compared to the lateral knee compartment during walking. This asymmetric load distribution between the medial and lateral compartments is correlated to the external knee adduction moment, where larger moments indicate an increase in the medial compartment load.

The goal of this project is to understand how the peak knee adduction moment can be reduced using external stimuli and gait retraining. This type of intervention study has direct application for trying to slow the rate of progression of medial compartment knee osteoarthritis. In order to reduce the peak knee adduction moment, this project has consisted of two different direct geometry shoe intervention studies, two different stimulus only studies, and a gait retraining study.

The direct geometry studies showed reductions in the peak knee adduction moment using either angled shoe soles or variable stiffness shoe soles. The stimulus only studies showed how the gait pattern could be altered without using direct geometry changes. The gait retraining study showed that both verbal instruction and a feedback system lowered the first peak of the knee adduction moment by teaching subjects to keep their weight on the medial side of their shoe during gait.

Simple, non-invasive interventions present a relatively risk free solution to reducing the peak knee adduction moment. By understanding how various stimuli effect the magnitude of the peak knee adduction moment, this project has made it possible to develop better interventions for controlling gait patterns that may reduce the risk of osteoarthritis progression.

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Cited By (1)

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2006	Andriacchi TP, Mündermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rhuematol. September 2006;18(5):514-518.