title: Prospective study on the effects of orthotic treatment for medial knee osteoarthritis in Chinese patients: clinical outcome and gait analysis.
abstract: OBJECTIVE
  To evaluate the effectiveness of various orthotic treatments for patients with isolated medial compartment osteoarthritis.
  
  
  METHODS
  Prospective cohort study with sequential interventions.
  
  
  METHODS
  University-affiliated hospital, Hong Kong.
  
  
  METHODS
  From December 2010 to November 2011, 10 patients with medial knee osteoarthritis were referred by orthopaedic surgeons for orthotic treatment. All patients were sequentially treated with flat insole, lateral-wedged insole, lateral-wedged insole with subtalar strap, lateral-wedged insole with arch support, valgus knee brace, and valgus knee brace with lateral-wedged insole with arch support for 4 weeks with no treatment break. Three-dimensional gait analysis and questionnaires were completed after each orthotic treatment.
  
  
  METHODS
  The Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analogue scale scores, and peak and mean knee adduction moments.
  
  
  RESULTS
  Compared with pretreatment, the lateral-wedged insole, lateral-wedged insole with arch support, and valgus knee brace groups demonstrated significant reductions in WOMAC pain score (19.1%, P=0.04; 18.2%, P=0.04; and 20.4%, P=0.02, respectively). The lateral-wedged insole with arch support group showed the greatest reduction in visual analogue scale score compared with pretreatment at 24.1% (P=0.004). Addition of a subtalar strap to lateral-wedged insoles (lateral-wedged insole with subtalar strap) did not produce significant benefit when compared with the lateral-wedged insole alone. The valgus knee brace with lateral-wedged insole with arch support group demonstrated an additive effect with a statistically significant reduction in WOMAC total score (-26.7%, P=0.01). Compliance with treatment for the isolated insole groups were all over 90%, but compliance for the valgus knee brace-associated groups was only around 50%. Gait analysis indicated statistically significant reductions in peak and mean knee adduction moments in all orthotic groups when compared with a flat insole.
  
  
  CONCLUSIONS
  These results support the use of orthotic treatment for early medial compartment knee osteoarthritis.
authors.affiliation: Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Henry C H
authors.initials: HC
authors.lastname: Fu
authors.affiliation: Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yaumatei, Hong Kong.
authors.forename: Chester W H
authors.initials: CW
authors.lastname: Lie
authors.affiliation: Private Practice, Hong Kong.
authors.forename: T P
authors.initials: TP
authors.lastname: Ng
authors.affiliation: Department of Prosthetics and Orthotics, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: K W
authors.initials: KW
authors.lastname: Chen
authors.affiliation: Department of Prosthetics and Orthotics, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: C Y
authors.initials: CY
authors.lastname: Tse
authors.affiliation: Department of Prosthetics and Orthotics, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: W H
authors.initials: WH
authors.lastname: Wong
mesh_terms: D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D001915:Braces; D015331:Cohort Studies; D005260:Female; D061826:Foot Orthoses; D005684:Gait / Q000502:physiology*; D006723:Hong Kong; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000628:therapy*; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Foot orthoses; Gait; Osteoarthritis, knee; Treatment outcome