Relationship Between Gait and Clinical Results After High Tibial Osteotomy

Wada, Makoto; Imura, Satoru; Nagatani, Kenji; Baba, H.; Shimada, Seiichiro; Sasaki, Shinichi

doi:10.1097/00003086-199809000-00022

Cited by 84 publications

(66 citation statements)

References 20 publications

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“…The predicted reductions of 32% to 56% in both peaks were extremely close to the decreases of 37% to 55% achieved by the patient after gait retraining. Furthermore, these decreases were comparable to the 30% to 50% observed following HTO surgery [3], [6], [9], which was the goal of the design process. The actual reductions achieved by the patient during normal walking would be somewhere within these ranges.…”

Section: Discussionsupporting

confidence: 63%

“…This torque exhibits two peaks during the gait cycle-one during early stance and the other during late stance. Only the first peak during early stance has been shown to be higher in patients with knee OA compared to healthy controls [3]- [5], making the first peak the most critical one to lower. Following HTO surgery, patients with the lowest first peak tend to have the best longterm outcome [6], [7], particularly those whose peak is below approximately 2.5% body weight times height (%BW * HT) [8].…”

Section: Introductionmentioning

confidence: 99%

“…Following HTO surgery, patients with the lowest first peak tend to have the best longterm outcome [6], [7], particularly those whose peak is below approximately 2.5% body weight times height (%BW * HT) [8]. Such patients typically obtain adduction torque reductions on the order of 30% to 50% from HTO surgery [3], [6], [9]. A high-peak knee adduction torque has also been correlated with higher proximal tibial bone density on the medial side [10], increased OA disease severity [11], and an increased rate of OA disease progression [12].…”

Section: Introductionmentioning

confidence: 99%

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Design of patient-specific gait modifications for knee osteoarthritis rehabilitation

Fregly

Reinbolt

Rooney

et al. 2007

IEEE Trans. Biomed. Eng.

213

164

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Gait modification is a nonsurgical approach for reducing the external knee adduction torque in patients with knee osteoarthritis (OA). The magnitude of the first adduction torque peak in particular is strongly associated with knee OA progression. While toeing out has been shown to reduce the second peak, no clinically realistic gait modifications have been identified that effectively reduce both peaks simultaneously. This study predicts novel patient-specific gait modifications that achieve this goal without changing the foot path. The modified gait motion was designed for a single patient with knee OA using dynamic optimization of a patient-specific, full-body gait model. The cost function minimized the knee adduction torque subject to constraints limiting how much the new gait motion could deviate from the patient's normal gait motion. The optimizations predicted a "medialthrust" gait pattern that reduced the first adduction torque peak between 32% and 54% and the second peak between 34% and 56%. The new motion involved three synergistic kinematic changes: slightly decreased pelvis obliquity, slightly increased leg flexion, and slightly increased pelvis axial rotation. After gait retraining, the patient achieved adduction torque reductions of 39% to 50% in the first peak and 37% to 55% in the second one. These reductions are comparable to those reported after high tibial osteotomy surgery. The associated kinematic changes were consistent with the predictions except for pelvis obliquity, which showed little change. This study demonstrates that it is feasible to design novel patient-specific gait modifications with potential clinical benefit using dynamic optimization of patient-specific, full-body gait models. Further investigation is needed to assess the extent to which similar gait modifications may be effective for other patients with knee OA.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Design of patient-specific gait modifications for knee osteoarthritis rehabilitation

Fregly

Reinbolt

Rooney

et al. 2007

IEEE Trans. Biomed. Eng.

213

164

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“…In addition, we have reported previously that the adduction moment decreased significantly soon after high tibial osteotomy but tended to increase gradually after one year. 32 Even after valgus alignment was obtained, the adduction moment tended to increase with time. Furthermore, logistic regression analysis showed that the risk of progression of knee OA increased 6.46 times with a 1% increase in adduction moment.…”

Section: Discussionmentioning

confidence: 99%

“…The two force plates were placed on the floor on either side of the centre line of an 8 m walkway. 32 The reflective skin markers for the light source measuring device were attached to both acromions, anterior superior iliac supine, iliac crest, greater trochanter, lateral joint line of the knee, lateral malleolus of the fibula, lateral side of the calcaneus, and the head of the fifth metatarsal bone. Signals of three dimensional reaction forces detected by the force plates were digitised through an analogue/digital converter and stored on a computer.…”

Section: Gait Analysismentioning

confidence: 99%

Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis

Miyazaki

2002

Annals of the Rheumatic Diseases

1,190

982

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Objective: To test the hypothesis that dynamic load at baseline can predict radiographic disease progression in patients with medial compartment knee osteoarthritis (OA). Methods: During 1991-93 baseline data were collected by assessment of pain, radiography, and gait analysis in 106 patients referred to hospital with medial compartment knee OA. At the six year follow up, 74 patients were again examined to assess radiographic changes. Radiographic disease progression was defined as more than one grade narrowing of minimum joint space of the medial compartment. Results: In the 32 patients showing disease progression, pain was more severe and adduction moment was higher at baseline than in those without disease progression (n=42). Joint space narrowing of the medial compartment during the six year period correlated significantly with the adduction moment at entry. Adduction moment correlated significantly with mechanical axis (varus alignment) and negatively with joint space width and pain score. Logistic regression analysis showed that the risk of progression of knee OA increased 6.46 times with a 1% increase in adduction moment. Conclusions:The results suggest that the baseline adduction moment of the knee, which reflects the dynamic load on the medial compartment, can predict radiographic OA progression at the six year follow up in patients with medial compartment knee OA.

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Test–retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis

Birmingham

Hunt

Jones

et al. 2007

Arthritis & Rheumatism

140

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Objective. To estimate the test-retest reliability of the peak external knee adduction moment during walking in patients with medial compartment knee osteoarthritis (OA), and to describe the interpretation of the reported values. Methods. A total of 31 patients diagnosed with knee OA confined primarily to the medial compartment underwent quantitative gait analyses during 2 separate test sessions at least 24 hours apart and within 1 week. The peak knee adduction moment was calculated for each patient at each session based on the mean of 5 walking trials. Reliability was estimated using the intraclass correlation coefficient (ICC 2,1 ) and the standard error of measurement (SEM). Conclusion. The ICC suggests that the peak knee adduction moment is appropriate for use when distinguishing among patients, for example, in studies of various interventions intended to decrease dynamic load on the knee medial compartment. The SEM illustrates the importance of considering measurement error and incorporating confidence levels when interpreting an individual patient's peak knee adduction moment value.

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Relationship Between Gait and Clinical Results After High Tibial Osteotomy

Cited by 84 publications

References 20 publications

Design of patient-specific gait modifications for knee osteoarthritis rehabilitation

Design of patient-specific gait modifications for knee osteoarthritis rehabilitation

Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis

Test–retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis

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