Continuous Professional Development Update

Evidenced Based Biomechanical Approach to Management of Medial Compartment Knee Osteoarthritis

14 April 2014
Room 103, Duke of Windsor Social Service Building, No. 15 Hennessy Road, Wanchai, Hong Kong

Knee OA has been described as a mechanical problem than needs mechanical solution. Much of the management of OA is concerning the realignment of the knee in the coronal plane, either surgically (e.g. high tibial osteotomy, Total Knee Replacements) or conservatively (e.g. bracing, lateral wedging).

Evidences show the increases in the knee adduction moment (KAM) has been associated with increased mechanical load at the knee and progression of knee osteoarthritis. Improvement in the adduction moment improves the patient’s knee function and reduces the loading on the medial compartment. Valgus knee braces and lateral wedged insoles are common approaches to reducing this loading. Recent research show improvement in knee loading after use of a specialized mobility shoes for knee osteoarthritis. Results of a 6-month RCT study show the use of mobility shoes results in significant reductions in knee loading and pain in patients with Knee OA, compared to the results of using common stiff-soled shoes. By 6 months, there was evidence of a gait adaptation with sustained load reduction even when the mobility shoes are removed.

Evidences show surgical management of Knee OA (e.g. Total Knee replacements) clearly can offer a correction on the knee varus angle and a reduction of the adduction moment, with self reported improvement of pain and function. However research evidences also show bracing, lateral wedge, specialized mobility shoes also offer significant effect in all these factors. Therefore conservative management could have a greater role in the preoperative management of medial compartment knee OA.