Biomechanical Correction by Lateral Wedge Outsole in Osteoarthritis Knee Joint

BackgroundWe aimed to evaluate the prevalence of hip and knee osteoarthritis (HOA and KOA) according to American College of Rheumatology (ACR) criteria among participants with suspected early symptomatic osteoarthritis (OA) in the CHECK cohort. We also assessed whether participants not fulfilling ACR criteria at baseline develop ACR-defined OA at 2-year and/or 5-year follow up, and which baseline factors are associated with this development.MethodsThe CHECK cohort included 1002 subjects with first presentation of knee and/or hip complaints. The primary outcome was onset of HOA and/or KOA according to the ACR criteria, including the clinical classification criteria and the combined clinical and radiographic classification criteria at 2-year and/or 5-year follow up.ResultsOf the participants with hip complaints, 63% (n = 370) were classified as having HOA at baseline according to the ACR criteria. Of those not classified with HOA at baseline, 40% developed HOA according to the clinical or combined clinical/radiographic ACR criteria after 2 and/or 5 years. Up to 92% of participants (n = 829) with knee complaints were classified as having KOA at baseline; of those not classified with KOA at baseline, 55% developed KOA according to the clinical ACR criteria or the clinical/radiographic ACR criteria after 2 and/or 5 years. The following factors were associated with development of HOA: morning stiffness (OR 2.39; 95% CI 1.14–4.98), painful internal rotation (OR 2.53; 95% CI 1.23–5.19), hip flexion < 115° (OR 2.33; 95% CI 1.17–4.64) and erythrocyte sedimentation rate (ESR) < 20 mm/h (OR 2.94; 95% CI 1.13–7.61). No variables were associated with development of KOA at 2-year and/or 5-year follow up.ConclusionsA large proportion of persons with hip complaints not fulfilling the ACR criteria at baseline develop HOA after 2 and/or 5 years of follow up. Almost all persons with knee complaints already fulfill the clinical and/or radiographic ACR criteria for OA, and half of the persons not fulfilling criteria at baseline will do so after 5 years of follow up. Several individual ACR criteria for HOA at baseline were associated with the development of HOA at follow up. This association was not proven for KOA, probably because of the small number of subjects developing KOA in this study.

The prevalence of osteoarthritis among elderly is high and it majorly affects the quality of life. Knee osteoarthritis is the most common form of osteoarthritis. Timely diagnosis using clinical criteria and effective intervention is of utmost importance. To estimate the prevalence and determinants of osteoarthritis of knee joint among elderly persons residing in an urban slum of Delhi using ACR clinical criteria. We did a community-based cross-sectional study among 496 elderly (>= 60 years) persons residing in urban slum of Delhi, India from December 2009 to February 2010. The American College of Rheumatology (ACR) criteria was used to clinically diagnose osteoarthritis knee. Bivariate analysis using Chi-square test and multivariate analysis was done to identify the determinants. Sensitivity and specificity of individual factors to diagnose osteoarthritis knee was calculated. The prevalence of osteoarthritis was estimated to be 41.1% (95% C.I., 36.7-45.6). Female sex and age >= 70 y were found to be independent risk factor for osteoarthritis knee. Among those having knee pain, presence of crepitus and tenderness were the most sensitive factors whereas bone overgrowth and bone warmth were most specific factors. The prevalence of osteoarthritis knee was high among this elderly population and increased with age. Overall, individual factors of ACR criteria were both sensitive and specific in diagnosing osteoarthritis knee. In resource constrained setting of urban India, it can be an effective tool in clinical diagnosis of osteoarthritis knee.

Background: Osteoarthritis is a common joint disease, with the acceleration of the aging process in China, it has troubled the middle-aged and elderly. There have been some epidemiological studies of osteoarthritis conducted in one single site, and most of them were on knee osteoarthritis. The results varied greatly between different surveys. There was still a lack of large-scale and multicenter epidemiological studies of osteoarthritis. This paper aimed to estimate the overall prevalence of lumbar osteoarthritis, cervical osteoarthritis, hand osteoarthritis, knee osteoarthritis, and hip osteoarthritis in the middle-aged and elderly in China by summarizing the existing publications. Methods: We comprehensively searched publications on 1 January 2019 in PubMed, Web of Science, Embase, Cochrane Library, CBM, CNNI, VIP, and Wan Fang. Epidemiological publications on osteoarthritis in the middle-aged and elderly Chinese published from 2000 to 2018 were summarized and analyzed by means of systematic review and meta-analysis. Data of prevalence of osteoarthritis in five joints were extracted from the included publications. The Hoy 2012 tool was used to assess the risk of bias of included studies. Results: After performing a systematic search in eight databases and manually searching, 3058 articles were obtained, and 21 articles were included in the meta-analysis. Lumbar osteoarthritis was the most prevalent with a prevalence of 25.03% (95% CI: 0.1444–0.3562). The prevalence of knee osteoarthritis followed, which was 21.51% (95% CI: 0.1873–0.2429). The prevalence of cervical osteoarthritis was 20.46% (95% CI: 0.1244–0.2849). The prevalence of hand osteoarthritis was 8.99% (95% CI: 0.0435–0.1364). The prevalence of hip osteoarthritis was not pooled due to its lack of data. Higher prevalence of knee, hand, lumbar, and cervical osteoarthritis was seen in the female group and southern regions. The prevalence of knee and hand osteoarthritis increased with age. The prevalence of lumbar and cervical osteoarthritis increased with age. There was also a trend that the prevalence increased with age before 70 years old and slightly decreased in the oldest ages. Conclusions: The lumbar joint was the joint most prevalently affected by osteoarthritis, followed by the prevalence of knee, cervical, hand, and hip joint osteoarthritis. Women, the southern population, and the older population are more susceptible to osteoarthritis. The paucity of epidemiology data of osteoarthritis in China appeals for more population-based surveys being conducted in the future. Based on the relatively high prevalence of osteoarthritis obtained from this review, self-management and community-based management should be considered, which can provide experience from the management of hypertensions and diabetes.

The aim of this cross-sectional study was to estimate the prevalence and risk factors of symptomatic knee and distal interphalangeal (DIP) joint osteoarthritis (OA) in the elderly (> or =50 years of age) urban population of Antalya, Turkey. According to the 1997 national census, Antalya's population was 508,840. By random cluster sampling, 655 individuals aged 50 years or more were interviewed face-to-face and subjected to structured interviews regarding knee pain, worsening pain on exertion, and the gelling phenomenon. They were also asked about performing namaz (a fundamental act of worship in Islam performed five times a day), smoking, type of residence, type of toilet, work style, and duration of walking per day. They were also questioned about swelling in DIP joints. In the case of suspicion of knee OA, the individuals were invited to the hospital for further evaluation by physical examination and direct roentgenogram. The diagnosis of knee OA was based on clinical or clinical and radiographic findings. The prevalence of symptomatic knee OA was determined as 14.8% in the population aged 50 years or over. Advanced age, female sex, namaz, and type of residence were found to be associated with knee OA. The rate of symptomatic knee OA was significantly lower in smokers and those walking more than 2 h per day. Female sex was also strongly associated with OA DIP joints. OA of DIP joints was found significantly associated with symptomatic knee OA. The latter is a major health problem in the elderly population, especially in about one fourth of women aged 50 years or over. These data suggest that advanced age, female sex, and type of residence are risk factors.

Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: influences of age, gender and osteoarthritis affecting other joints

ObjectiveEpidemiological studies of knee osteoarthritis (OA) have often used a radiographic definition. However, the clinical syndrome of OA is influenced by a broad range of factors in addition to the structural changes required for radiographic OA. Hence more recently several studies have adopted a clinical or self-reported approach to OA diagnosis rather than a radiographic approach. The aim of this study was to investigate agreement between radiographic OA and the clinical and self-reported diagnoses of OA.DesignData were available for 199 men and 196 women in the Hertfordshire Cohort Study (HCS), UK. Participants completed a questionnaire detailing self-reported OA. Clinical OA was defined based on American College of Rheumatology (ACR) criteria. Knee radiographs were taken and graded for overall Kellgren and Lawrence (K&L) score.ResultsThe mean (standard deviation (SD)) age of study participants was 75.2 (2.6) years and almost identical proportions of men and women. The prevalence of knee OA differed depending on the method employed for diagnosis; 21% of the study participants self-reported knee OA, 18% of the participants had clinical knee OA and 42% of the participants had radiographic OA. Of those 72 study participants with a self-reported diagnosis of knee OA 52 (72%) had a radiographic diagnosis of knee OA, while 66% (39 out of 59) of study participants with clinical knee OA had a diagnosis of radiographic knee OA. However 58% of those participants diagnosed with radiographic OA did not have either self-reported knee OA or a diagnosis of clinical OA. Therefore in comparison with the radiographic definition of OA, both the clinical and self-report definitions had high specificity (91.5% & 91.5% respectively) and low sensitivity (24.5% and 32.7% respectively).ConclusionThere is modest agreement between the radiographic, clinical and self-report methods of diagnosis of knee OA.

Comparison of three sets of clinical classification criteria for knee osteoarthritis: a cross-sectional study of 13,459 patients treated in primary care

The increasing number of patients with developing osteoarthritis is accompanied by a growing scientific interest in non-operative early treatment strategies. It is generally believed that laterally wedged insoles can change the distribution of knee loading. However, the importance of footwear design/type on the effectiveness of lateral wedging has not been investigated so far. The Purpose of the present study was to explore alterations in knee loading due to lateral foot wedges in three different shoes. Methods: Thirteen healthy participants with no history of knee pain were tested using three-dimensional gait analysis. Barefoot walking, walking in a running shoe, an Oxford-type leather shoe, and a rocker shoe were analysed. The shoes were tested both with and without a 10-degree full-length laterally wedged insole. Results: There were significant shoe*wedge interactions on the first and second peak knee adduction moments. However, the variability of this moment between shoe designs was of similar magnitude as the effect of laterally wedged insoles. Only marginal changes in muscle activity for gastrocnemius when walking with the wedged Oxford shoe were revealed. Conclusion: Lateral wedging is effective regardless of shoe design. Differences between the three neutral walking conditions underline the importance of footwear choice in individuals. It is safe to apply lateral wedges without jeopardising muscular control during walking regardless of shoe type. Possible effects of altering neuromuscular control by shoe type needs further exploration in patient groups.

Lateral wedges are often prescribed to increase the first metatarsophalangeal joint (MPJ) range of motion or alter the centre of pressure (COP) in the foot. This study explored the effect of lateral wedge design and placement on first MPJ extension and COP during walking and running gait. A randomised crossover design was used and 24 healthy participants ran and walked in 10 insole conditions comprising differing combinations of inclination, placement and contour. First MPJ extension and foot COP were examined. Time-series data were analysed across the stance phase using statistical parametric mapping. Lateral wedges significantly reduced first MPJ extension during both walking (p < 0.001; 100% of stance) and running (p = 0.004; 14-72%, and p = 0.017; 76-99% of stance). Similarly, lateral wedge placement reduced first MPJ joint extension during walking (p < 0.001; 100% of stance) and running (p = 0.003; 13-69%, and p = 0.012; 78-100%). Full-length or 6° lateral wedges shifted the COP medially relative to the midline of the foot (p = 0.01). Compared to sham, lateral wedges placed on contoured insoles exhibited a smaller reduction in first MPJ during walking (p = 0.008) and shifted the COP medially during both walking (p < 0.001) and running (p = 0.020). Where the intention of using lateral wedging is to shift the COP medially, these data indicate that a wedge which is of higher inclination (6°) or spanning the full-length of the insole, should be used. Conversely, if the goal is to reduce extension at the first MPJ, these findings suggest that both 3° and 6° inclination wedges are suitable, with either forefoot or full-length applications proving effective.

Daily use of a cane for two months reduced pain and improved function in patients with knee osteoarthritis

There is no clear published estimate of the prevalence of diagnosed knee osteoarthritis based on consultation in primary care. Further, little is known about the clinical history of patients who are subsequently diagnosed with knee osteoarthritis. Our aims were (i) to determine the prevalence of knee osteoarthritis diagnosed in primary care; (ii) to compare the medical history of patients currently diagnosed with knee osteoarthritis with that of controls; and (iii) to determine factors associated with X-ray at the time of first diagnosis. A case-control study was carried out in one general practice in North Staffordshire. Cases aged > or =45 years were identified from computer searches for knee osteoarthritis between 1 January 1998 and 31 January 2000. Matched controls had no diagnosis of knee osteoarthritis during that same period. The medical records for both groups were examined to identify recorded knee-related symptoms, X-rays and secondary care referrals. A total of 146 cases and controls were reviewed; 49% of cases and 15% of controls had a previous (pre-1998) diagnosis of knee osteoarthritis. This gives an estimated prevalence of diagnosed knee osteoarthritis in the general population aged > or =45 years of 12.5%. Cases were more likely to have had a prior history of knee-related disorders, X-rays and referral to secondary care than controls. There was no association between an X-ray at first diagnosis and previous knee symptoms (odds ratio 0.98; 95% confidence interval 0.49-1.97) and only weak associations of X-ray with gender (male), age (under 60) of patient and time of diagnosis (pre-1998). Diagnosed knee osteoarthritis is common in general practice and diagnosed patients often have a long history of knee symptoms prior to diagnosis. Further research might usefully consider what influences GPs' diagnosis of knee osteoarthritis and how diagnosis relates to management and outcome.

BackgroundOsteoarthritis (OA) is a common and disabling disease that places a significant burden on both patients and health care systems. Previous studies have already shown that patients with OA have...

The role of imaging modalities in the diagnosis, differential diagnosis and clinical assessment of peripheral joint osteoarthritis

BackgroundTo investigate the prevalence and characteristics of osteoarthritis (OA) in Mongolian middle-aged and senior residents of the Inner Mongolia autonomous region, compared with the prevalence of OA in different regions, to understand the OA-associated factors and provide theoretical evidences for intervention and prevention.ObjectivesThereby the prevalence, distribution characteristics and correlative factors of OA in Mongolian middle-aged and senior residents in the Inner Mongolia autonomous region were investigated in this study.Materials and MethodsRural and urban residents in Hohhot, Baotou and Erdos were selected using stratified, multi-stage and cluster random sampling. 2000 residents aging over 45 filled out questionnaires, underwent specialized physical and X-ray examinations. The factors affecting OA were analyzed by the multivariate unconditional logistic regression.ResultsObtained total of 1877 questionnaires were completed. 93% of the residents were unaware of OA-related issues. The prevalence of radiological OA and clinical OA (neck OA: 36.72%; waist OA: 44.02%; knee OA: 12.43%; hand OA: 6.83%) were 62.17% and 56.15%, respectively. Urban residents were more subjected to cervical spine (χ2 = 8.92, P = 0.005) and less to lumbar spine disease (χ2 = 10.32, P = 0.004) compared to rural ones. The prevalence of OA in knees and hands of females (χ2 = 8.65, P = 0.003) was significantly higher than males (χ2=4.37, P=0.042). The prevalence of OA in postmenopausal females was slightly higher than males (χ2 = 3.86, P = 0.052), with no statically significant difference. The risks of OA obviously increased with age. The residents with hypertension, diabetes and atherosclerosis were more subjected to OA.ConclusionsThe prevalence of OA in Mongolian middle-aged and senior residents in part of the Inner Mongolia autonomous region was similar to the other ethnic groups. The prevalence of OA was affected by age, gender, location, hypertension, diabetes, atherosclerosis and osteoporosis. The residents need further educations about OA prevention and treatment.

Background and aim : Osteoarthritis of knee is the most common joint disorder, accounting for a large rate of disability in elderly that affected both genders equally. The patients with severe knee osteoarthritis complain of considerable pain and immobility and functional limitations. The medial compartment of the knee affected more often than lateral compartment. One of the conservative treatments proposed for this disorder is the lateral wedge insole. The aim of this study was to compare the effect of different insoles (in-shoe and out-shoe wedges) with the height of 7mm on the replacement of foot’s center of pressure in patients with severe medial knee osteoarthritis . Materials M in-shoe lateral heel wedge, in-shoe full length lateral wedge, in-shoe lateral heel wedge with medial arc support, in-shoe full length wedge with medial arc support, out-shoe lateral heel wedge, out-shoe full length lateral wedge and, without any wedge. Foot scan setting was used for evaluating and data collection. Repeated Measures ANOVA test was used to analyze the data. Results: Different in-shoe and out-shoe wedges had different effects on the displacement of the center of pressure (P<0.0001). The comparison across different lateral wedges with height of 7mm suggested that out-shoe full length Lateral wedge has the most effect in lateralization of foot center of pressure followed by in-shoe lateral heel wedge with medial arc support, in-shoe lateral heel wedge, in-shoe full length wedge and in-shoe full length wedge with medial arch support. Conclusion: Among the investigated in-sole and out-sole wedges the lateral full length out-shoe wedge has the greatest effect on the lateral displacement of foot center of pressure. Key words: knee osteoarthritis, Insole, center of pressure.