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PURPOSE: Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer-term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment. METHODS: Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM. RESULTS: An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO. CONCLUSION: The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes. LEVEL OF EVIDENCE: Therapeutic study level I randomised crossover trial.
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BACKGROUND: Patients with acetabular dysplasia have an abnormal acetabular geometry which results in insufficient coverage of the femoral head. This coverage deficiency reduces contact surfaces within the joint, accelerating the wear of the articular cartilage and predisposing patients to early osteoarthritis. Periacetabular osteotomy is a surgical treatment of acetabular dysplasia that aims to reorient the acetabulum relative to the femoral head, increasing coverage. METHODS: Pelvic kinematics and lower limbs joint kinematics and kinetics during the stance phase of gait were recorded using a 3D motion capture system and force plates, then compared pre- to post- and between limbs with a repeated measures 2-way ANOVA. Radiographic measurements and gait parameters were compared pre- to post-surgery using a t-test for dependant samples. To identify predictors of pelvic symmetry improvements during gait, a multivariate analysis was performed using a forward stepwise linear regression. FINDINGS: Radiographic measurements improved for all participants while gait parameters remained unchanged. Hip flexion symmetry was improved following surgery. The external rotation moment of the healthy hip was reduced after surgery (-29%) resulting in increased asymmetry. Pelvic tilt was significantly greater on the affected side (+0.5°) during the loading response, and the difference tended to be greater after surgery (+0.8°). INTERPRETATION: Unilaterally affected dysplastic patients have an asymmetrical gait pattern that is only partially corrected by periacetabular osteotomy even when radiographic and clinical targets are met. Differences between the limbs could be explained in part by a learned antalgic pattern and muscle weaknesses leading to complex compensation mechanisms.