Changes in in vivo knee loading with a variable‐stiffness intervention shoe correlate with changes in the knee adduction moment

External knee adduction moment can be reduced using footwear interventions, but the exact changes in in vivo medial joint loading remain unknown. An instrumented knee replacement was used to assess changes in in vivo medial joint loading in a single patient walking with a variable‐stiffness intervention shoe. We hypothesized that during walking with a load modifying variable‐stiffness shoe intervention: (1) the first peak knee adduction moment will be reduced compared to a subject's personal shoes; (2) the first peak in vivo medial contact force will be reduced compared to personal shoes; and (3) the reduction in knee adduction moment will be correlated with the reduction in medial contact force. The instrumentation included a motion capture system, force plate, and the instrumented knee prosthesis. The intervention shoe reduced the first peak knee adduction moment (13.3%, p = 0.011) and medial compartment joint contact force (12.3%; p = 0.008) compared to the personal shoe. The change in first peak knee adduction moment was significantly correlated with the change in first peak medial contact force (R2 = 0.67, p = 0.007). Thus, for a single subject with a total knee prosthesis the variable‐stiffness shoe reduces loading on the affected compartment of the joint. The reductions in the external knee adduction moment are indicative of reductions in in vivo medial compressive force with this intervention. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1548–1553, 2010

[1]  W. T. Dempster,et al.  Properties of body segments based on size and weight , 1967 .

[2]  S. Ahlbäck.  Osteoarthrosis of the knee. A radiographic investigation. , 1968, Acta radiologica: diagnosis.

[3]  D. Resnick,et al.  Compartmental evaluation of osteoarthritis of the knee. A comparative study of available diagnostic modalities. , 1975, Radiology.

[4]  E Y Chao,et al.  Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force. , 1976, The Journal of bone and joint surgery. American volume.

[5]  W Waugh,et al.  The distribution of load across the knee. A comparison of static and dynamic measurements. , 1980, The Journal of bone and joint surgery. British volume.

[6]  T. Andriacchi,et al.  The influence of total knee-replacement design on walking and stair-climbing. , 1982, The Journal of bone and joint surgery. American volume.

[7]  R. N. Stauffer,et al.  Normative data of knee joint motion and ground reaction forces in adult level walking. , 1983, Journal of biomechanics.

[8]  M. B. Coventry.  Upper Tibial Osteotomy , 1984, Clinical orthopaedics and related research.

[9]  Edmund Y. S. Chao,et al.  Results of Proximal Tibial Osteotomy , 1985 .

[10]  T. Andriacchi,et al.  A relationship between gait and clinical changes following high tibial osteotomy. , 1985, The Journal of bone and joint surgery. American volume.

[11]  L. Kazis,et al.  The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. , 1987, Arthritis and rheumatism.

[12]  T. Andriacchi,et al.  The influence of walking mechanics and time on the results of proximal tibial osteotomy. , 1990, The Journal of bone and joint surgery. American volume.

[13]  T. Andriacchi,et al.  Interaction between active and passive knee stabilizers during level walking , 1991, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[14]  T. Andriacchi,et al.  Musculoskeletal dynamics, locomotion, and clinical applications , 1991 .

[15]  T. Andriacchi.  Dynamics of knee malalignment. , 1994, The Orthopedic clinics of North America.

[16]  T. Andriacchi,et al.  Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. , 1998, Arthritis and rheumatism.

[17]  M. Wada,et al.  Relationship Between Gait and Clinical Results After High Tibial Osteotomy , 1998, Clinical orthopaedics and related research.

[18]  S. Crenshaw,et al.  Effects of Lateral-Wedged Insoles on Kinetics at the Knee , 2000, Clinical orthopaedics and related research.

[19]  T. Miyazaki,et al.  Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis , 2002, Annals of the rheumatic diseases.

[20]  T. Andriacchi,et al.  Increased knee joint loads during walking are present in subjects with knee osteoarthritis. , 2002, Osteoarthritis and cartilage.

[21]  D. Kerrigan,et al.  Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis. , 2002, Archives of physical medicine and rehabilitation.

[22]  David G Lloyd,et al.  Repeatability of gait data using a functional hip joint centre and a mean helical knee axis. , 2003, Journal of biomechanics.

[23]  T. Andriacchi,et al.  Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. , 2004, Arthritis and rheumatism.

[24]  F. Breedveld,et al.  Osteoarthritis--the impact of a serious disease. , 2004, Rheumatology.

[25]  D. D’Lima,et al.  An implantable telemetry device to measure intra-articular tibial forces. , 2005, Journal of biomechanics.

[26]  T. Schmalz,et al.  The influence of sole wedges on frontal plane knee kinetics, in isolation and in combination with representative rigid and semi-rigid ankle-foot-orthoses. , 2006, Clinical biomechanics.

[27]  M. Wada,et al.  Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis. , 2006, Archives of physical medicine and rehabilitation.

[28]  T. Andriacchi,et al.  In healthy subjects without knee osteoarthritis, the peak knee adduction moment influences the acute effect of shoe interventions designed to reduce medial compartment knee load , 2007, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[29]  B. Fregly,et al.  Correlation between the knee adduction torque and medial contact force for a variety of gait patterns , 2007, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[30]  Dong Zhao,et al.  In vivo medial and lateral tibial loads during dynamic and high flexion activities , 2007, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[31]  Irene S Davis,et al.  The effect of a subject‐specific amount of lateral wedge on knee mechanics in patients with medial knee osteoarthritis , 2007, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[32]  T. Andriacchi,et al.  A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis. , 2008, Journal of biomechanics.

[33]  B. Fregly,et al.  Effective gait patterns for offloading the medial compartment of the knee , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[34]  Annegret Mündermann,et al.  Changes in knee adduction moment, pain, and functionality with a variable‐stiffness walking shoe after 6 months , 2010, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.