Document Detail

Lateral wedges in knee osteoarthritis: what are their immediate clinical and biomechanical effects and can these predict a three-month clinical outcome?
MedLine Citation:
PMID:  18311763     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess immediate effects of laterally wedged insoles on walking pain, external knee adduction moment, and static alignment, and whether these immediate effects together with age, body mass index, and disease severity predict clinical outcome after 3 months of wearing insoles in medial knee osteoarthritis. METHODS: Forty volunteers (mean age 64.7 years, 16 men) were tested in random order with and without a pair of 5 degrees full-length lateral wedges. Immediate changes in static alignment were measured via radiographic mechanical axis and changes in adduction moment via 3-dimensional gait analysis. After 3 months of treatment with insoles, changes in pain and physical functioning were assessed via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and patient-perceived global change scores. RESULTS: Reductions in the adduction moment occurred with insoles (first peak mean [95% confidence intervals (95% CI)] -0.22 [-0.28, -0.15] Nm/body weight x height %), accompanied by a reduction in walking pain of approximately 24% (mean [95% CI] -1.0 [-4.0, 2.0]). Insoles had no mean effect on static alignment. Mean improvement in WOMAC pain (P = 0.004) and physical functioning (mean [95% CI] -6 [-11, -1]) was observed at 3 months, with 25 (69%) and 26 (72%) of 36 individuals reporting global improvement in pain and functioning, respectively. Regression analyses demonstrated that disease severity, baseline functioning, and magnitude of immediate change in walking pain and the first peak adduction moment with insoles were predictive of clinical outcome at 3 months. CONCLUSION: Lateral wedges immediately reduced knee adduction moment and walking pain but had no effect on static alignment. Although some parameters predicted clinical outcome, these explained only one-third of the variance, suggesting that other unknown factors are also important.
Rana S Hinman; Craig Payne; Ben R Metcalf; Tim V Wrigley; Kim L Bennell
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  59     ISSN:  0004-3591     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-24     Completed Date:  2008-04-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  408-15     Citation Subset:  AIM; IM    
Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
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MeSH Terms
Gait / physiology
Knee Joint / physiology*
Middle Aged
Orthotic Devices*
Osteoarthritis, Knee / complications,  therapy*
Pain / etiology,  prevention & control*
Posture / physiology
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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