Clinical Phenotype Classifications Based on Static Varus Alignment and Varus Thrust in Japanese Patients With Medial Knee Osteoarthritis

Iijima, Hirotaka; Fukutani, Naoto; Aoyama, Tomoki; Fukumoto, Takahiko; Uritani, Daisuke; Kaneda, Eishi; Ota, Kazuo; Kuroki, Hiroshi; Matsuda, Shuichi

doi:10.1002/art.39224

Cited by 41 publications

(31 citation statements)

References 43 publications

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“…As knee symptoms are more indicative of clinical intervention than structural changes, separate inquiry into the relation of varus knee thrust to knee symptoms (i.e., pain) is warranted. Previous studies have shown a cross‐sectional association between varus knee thrust and knee pain . Longitudinal data are lacking to confirm the directionality of the relationship between thrust and pain and to describe the effect of thrust on both the onset of new pain and worsening of existing pain.…”

Section: Introductionmentioning

confidence: 99%

Association of Varus Knee Thrust During Walking With Worsening Western Ontario and McMaster Universities Osteoarthritis Index Knee Pain: A Prospective Cohort Study

Wink

Gross

Brown

et al. 2019

Arthritis Care & Research

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Objective. To investigate the 2-year association of varus knee thrust observed during walking to the odds of worsening Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain in older adults with or at risk of osteoarthritis (OA).Methods. Video recordings of self-paced walking trials of Multicenter Osteoarthritis Study participants were assessed for the presence of varus thrust at baseline. Knee pain was assessed using the WOMAC questionnaire at baseline and at 2 years. Logistic regression was used to estimate the odds of worsening knee pain (defined as either any increase in WOMAC score or as clinically important worsening), adjusting for age, sex, race, body mass index, clinic site, gait speed, and static knee alignment. Analyses were repeated, stratified by baseline radiographic OA status and among the subset of knees without baseline WOMAC pain.Results. A total of 1,623 participants contributed 3,204 knees. Varus thrust was observed in 31.5% of knees. Knees with varus thrust had 1.44 times (95% confidence interval [95% CI] 1.19-1.73) the odds of any worsening and 1.37 times (95% CI 1.11-1.69) the odds of clinically important worsening WOMAC pain compared to knees without thrust. Knees with thrust without baseline WOMAC pain had 2.01 times (95% CI 1.47-2.74) the odds of incident total pain.Conclusion. Results indicate that varus thrust is a risk factor for worsening and incident knee pain. Targeting varus thrust through noninvasive therapies could prevent development or worsening of knee pain in older adults with or at risk for knee OA.

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Section: Introductionmentioning

confidence: 99%

Association of Varus Knee Thrust During Walking With Worsening Western Ontario and McMaster Universities Osteoarthritis Index Knee Pain: A Prospective Cohort Study

Wink

Gross

Brown

et al. 2019

Arthritis Care & Research

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“…A second limitation is that thrust was assessed by only one observer, and therefore this study lacks inter-rater reliability data. Using a similar protocol to ours, Iijima et al 19 reported good inter-rater reliability ( κ = 0.73) for visual assessment of thrust. While we report strong intra-rater reliability, having multiple readers with varying levels of experience would strengthen our findings.…”

Section: Discussionmentioning

confidence: 53%

“…Previous authors have found significant associations between varus knee thrust and knee pain 4,19 . Our findings of an association between thrust and incident and worsening BMLs suggest a potential mechanism for the relation of thrust to knee pain.…”

Section: Discussionmentioning

confidence: 90%

“…These results are similar to the findings of Chang et al 3 who saw a three-fold increase in the odds of radiographic OA progression in varus-aligned knees with varus thrust compared to varus-aligned knees without thrust. Furthermore, Lo et al 4 and Iijima et al 19 reported that varus thrust was more strongly correlated with knee pain than was static varus malalignment alone. Considered together, these findings suggest that dynamic malalignment (i.e., thrust) has potential to compound the trauma placed on the tibiofemoral joint by static malalignment.…”

Section: Discussionmentioning

confidence: 99%

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Varus thrust during walking and the risk of incident and worsening medial tibiofemoral MRI lesions: the Multicenter Osteoarthritis Study

Wink

Gross

Brown

et al. 2017

Osteoarthritis and Cartilage

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SUMMARY Objective To determine the association of varus thrust during walking to incident and worsening medial tibiofemoral cartilage damage and bone marrow lesions (BMLs) over 2 years in older adults with or at risk for osteoarthritis (OA). Method Subjects from the Multicenter Osteoarthritis Study (MOST) were studied. Varus thrust was visually assessed from high-speed videos of forward walking trials. Baseline and two-year MRIs were acquired from one knee per subject and read for cartilage loss and BMLs. Logistic regression with generalized estimating equations was used to estimate the odds of incident and worsening cartilage loss and BMLs, adjusting for age, sex, race, body mass index (BMI), and clinic site. The analysis was repeated stratified by varus, neutral, and valgus alignment. Results 1 007 participants contributed one knee each. Varus thrust was observed in 29.9% of knees. Knees with thrust had 2.17 [95% CI: 1.51, 3.11] times the odds of incident medial BML, 2.51 [1.85, 3.40] times the odds of worsening medial BML, and 1.85 [1.35, 2.55] times the odds of worsening medial cartilage loss. When stratified by alignment, varus knees also had significantly increased odds of these outcomes. Conclusion Varus thrust observed during walking is associated with increased odds of incident and worsening medial BMLs and worsening medial cartilage loss. Increased odds of these outcomes persist in varus-aligned knees.

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“…In varus-aligned knees, findings persisted (adjusted OR 3.17 [95% CI 1.60, 6.31]) (1). Previous studies have shown that varus thrust is associated with knee symptoms (15)(16)(17), including pain during weight-bearing activities (15).…”

Section: Discussionmentioning

confidence: 95%

Varus Thrust and Incident and Progressive Knee Osteoarthritis

Sharma

Chang

Jackson

et al. 2017

Arthritis & Rheumatology

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Background To determine if varus thrust, bowing-out of the knee during gait, i.e., the first appearance or worsening of varus alignment during stance, is associated with incident and progressive knee osteoarthritis (OA), we undertook an Osteoarthritis Initiative ancillary study. We further considered hypothesized associations adjusted for static alignment, anticipating some attenuation. Methods 2–3 trained examiners/site at 4 sites observed gait. In eligible knees, incident OA was analyzed as subsequent incident KL≥2, whole and partial-grade medial joint space narrowing (JSN), and annualized loss of joint space width (JSW), and progression as medial JSN and JSW loss. Outcomes were assessed over up to 7 years of follow-up. Analyses were knee-level, using multivariable logistic and linear regression with GEE to account for between-limb correlation. Results The incident OA sample included 4187 knees/2610 persons; the progression sample included 3421 knees/2284 persons. In knees with OA, thrust was associated with progression by each outcome adjusting for age, gender, BMI, and pain. In knees without OA, varus thrust was not associated with incident OA or other outcomes. After adjustment for alignment, the thrust/progression association was attenuated but an independent association persisted for partial grade JSN and JSW loss outcome models. WOMAC Pain and alignment were consistently associated with all outcomes. Within the stratum of varus knees, thrust was associated with an increased risk of progression. Conclusions Varus thrust visualized during gait is associated with knee OA progression and should be a target of intervention development.

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Clinical Phenotype Classifications Based on Static Varus Alignment and Varus Thrust in Japanese Patients With Medial Knee Osteoarthritis

Cited by 41 publications

References 43 publications

Association of Varus Knee Thrust During Walking With Worsening Western Ontario and McMaster Universities Osteoarthritis Index Knee Pain: A Prospective Cohort Study

Association of Varus Knee Thrust During Walking With Worsening Western Ontario and McMaster Universities Osteoarthritis Index Knee Pain: A Prospective Cohort Study

Varus thrust during walking and the risk of incident and worsening medial tibiofemoral MRI lesions: the Multicenter Osteoarthritis Study

Varus Thrust and Incident and Progressive Knee Osteoarthritis

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