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      Ineffectiveness of lateral-wedge insoles on the improvement of pain and function for medial knee osteoarthritis: a meta-analysis of controlled randomized trials

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          Abstract

          Objective

          The study aimed to evaluate the role of lateral-wedge insoles in pain reduction and functional improvement among patients with medial knee osteoarthritis.

          Materials and methods

          Three databases including Pubmed, Embase, and Web of science were searched from inception until October 2017 for studies investigating the role of lateral-wedge treatment in pain relief and functional recovery among patients with knee osteoarthritis. Eligible studies were pooled using fixed effect model or random-effects model based on Cochrane Q statistic and I 2 test. Moreover, subgroup analysis stratified by research area was performed, and sensitivity analysis was further designed to evaluate the strength of the meta-analysis.

          Results

          Ten studies with a total of 938 patients, of which 478 patients received lateral-wedge insoles and 460 patients were set as control, were included in the meta-analysis. The pooled statistics did not show significant improvement in knee pain (SMD = − 0.21, 95% CI − 0.50, 0.08; P = 0.16) and knee function (SMD = 0.22, 95% CI − 0.27, 0.70; P = 0.38) in lateral-wedge insoles treatment group compared with controls. However, subgroup analysis based on research area revealed a favorable outcome toward Asian patients who received lateral-wedge insoles in pain reduction when compared with control group. (SMD = − 0.88, 95% CI − 1.59, − 0.17; P = 0.02). No significant improvement was observed among patients in USA and other areas. Sensitivity analysis showed unchanged results when we omitted each study. No significant publication bias was observed among the included studies.

          Conclusion

          Though for young Asian patients within normal BMI, to some extent, the lateral-wedge insoles seems to be helpful. However, there was no evidence to demonstrate the relationship between race and role of lateral-wedge insoles on pain reduction. All in all, based on current data, lateral-wedge insoles appear to be ineffective at attenuating knee pain and function improvement.

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          Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis.

          T. Miyazaki, M. Wada, H. Kawahara … (2002)
          To test the hypothesis that dynamic load at baseline can predict radiographic disease progression in patients with medial compartment knee osteoarthritis (OA). During 1991-93 baseline data were collected by assessment of pain, radiography, and gait analysis in 106 patients referred to hospital with medial compartment knee OA. At the six year follow up, 74 patients were again examined to assess radiographic changes. Radiographic disease progression was defined as more than one grade narrowing of minimum joint space of the medial compartment. In the 32 patients showing disease progression, pain was more severe and adduction moment was higher at baseline than in those without disease progression (n=42). Joint space narrowing of the medial compartment during the six year period correlated significantly with the adduction moment at entry. Adduction moment correlated significantly with mechanical axis (varus alignment) and negatively with joint space width and pain score. Logistic regression analysis showed that the risk of progression of knee OA increased 6.46 times with a 1% increase in adduction moment. The results suggest that the baseline adduction moment of the knee, which reflects the dynamic load on the medial compartment, can predict radiographic OA progression at the six year follow up in patients with medial compartment knee OA.
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            Knee adduction moment and development of chronic knee pain in elders.

            Shreyasee Amin, Adrienne Krebs, Chris A McGibbon … (2004)
            To determine whether the adduction moment at the knee during locomotor activity contributes to the development of future chronic knee pain. We studied 132 community-dwelling elders who had undergone a full kinetic and kinematic motion analysis while performing 4 different activities: standing, walking, rising from a chair, and descending stairs. We contacted the participants 3-4 years after their baseline locomotion analysis and identified those who reported no knee pain at the time of motion analysis but who subsequently developed new chronic knee pain at followup. We examined whether the development of new chronic knee pain was associated with higher peak adduction moment at the knee during activities, measured at baseline. Of the 132 elders evaluated in 1995-1996, 118 (89%) were contacted in 1999. Of the 118 contacted, 80 (mean age 75 years; 78% women) had no lower extremity prosthetic joints at baseline, no known underlying inflammatory arthritis at baseline nor followup, and no baseline knee pain. At followup, 7 had developed new chronic knee pain defined as pain or stiffness on most days of the month and with walking 2 blocks or using stairs. Compared with those who did not develop knee pain, those who did develop new chronic knee pain had higher baseline adduction moments for all activities (P = 0.01), ranging from 8% higher during chair rise to 39% higher during stair descent. We found that greater adduction moment at the knee during activities contributes to the development of future chronic knee pain. Our results suggest that biomechanical factors may play an important role in the pathogenesis of knee pain and should be studied further.
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              Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis.

              Jennifer Lelas, Joyce Goggins, David T Felson … (2002)
              To test whether a lateral-wedged insole, inclined at 5 degrees or 10 degrees, significantly reduces knee varus torque during walking in patients with knee osteoarthritis compared with both using no insole and with wearing nonwedged control insoles of the same material and average thickness. Patients with medial knee osteoarthritis were studied while they walked wearing their comfortable shoes (1) without an insole; (2) with a 5 degrees lateral wedge compared with a nonwedged, 3.175-mm (1/8-in) even-thickness control insole; and (3) with a 10 degrees lateral wedge compared with a nonwedged 6.35-mm ((1/4)-in) even-thickness control insole. A gait laboratory with 3-dimensional motion analysis and force platform equipment. Fifteen patients with clinical and radiographic osteoarthritis of the medial compartment of 1 knee. Not applicable. Peak external knee varus torques during the stance period of gait. Data regarding lower-extremity joint torques and motions were collected, and knee joint torques using the different insoles and wedges were compared by analysis of variance. Although responses varied among individuals, as a group, both the 5 degrees and 10 degrees lateral-wedge insoles significantly reduced the knee varus torque during walking compared with walking with no insole and walking with nonwedged 3.175-mm and 6.35-mm control insoles. Compared with no insole, the 5 degrees wedge reduced the peak knee varus torque values by about 6% and the 10 degrees wedge reduced the peaks by about 8%. Although there were no significant differences in speed of walking between the conditions, the 10 degrees wedge and 6.35-mm control insoles were associated with varying degrees of discomfort. Both wedge insoles are effective in reducing the varus torque during walking beyond what theoretically could be explained by a reduced walking speed or cushioning effect from the insole. These data imply that wedged insoles are biomechanically effective and should reduce loading of the medial compartment in persons with medial knee osteoarthritis. Although the effect of the 5 degrees wedge was smaller, it may be more comfortable than the 10 degrees wedge to wear inside one's own shoes. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
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                Author and article information

                Contributors
                Junfeng Zhang: +86-0351-7553183 , sxzhangjf163@163.com
                Qin Wang: wqcc302@sina.com
                Cuiming Zhang: zhangcmty@163.com
                Journal
                Journal ID (nlm-ta): Arch Orthop Trauma Surg
                Journal ID (iso-abbrev): Arch Orthop Trauma Surg
                Title: Archives of Orthopaedic and Trauma Surgery
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0936-8051
                ISSN (Electronic): 1434-3916
                Publication date (Electronic): 20 July 2018
                Publication date PMC-release: 20 July 2018
                Publication date (Print): 2018
                Volume: 138
                Issue: 10
                Pages: 1453-1462
                Affiliations
                [1 ]GRID grid.263452.4, Department of Health Statistics, , Public Health of Shanxi Medical University, ; Taiyuan, 030001 Shanxi China
                [2 ]Publishing house, Chinese Journal of Rheumatology, Taiyuan, 030001 Shanxi China
                [3 ]GRID grid.263452.4, Department of Ultrasound, , The 2nd Hospital of Shanxi Medical University, ; Taiyuan, 030001 Shanxi China
                [4 ]ISNI 0000 0004 1798 5117, GRID grid.412528.8, Department of Nephrology and Rheumatology, , Shanghai Jiaotong University Affiliated Sixth People’s Hospital South Campus, ; Shanghai, China
                [5 ]Department of Nephrology and Rheumatology, Fengxian Hospital Affiliated to Southern Medical University, Shanghai, 201400 China
                Article
                Publisher ID: 3004
                DOI: 10.1007/s00402-018-3004-z
                PMC ID: 6132949
                PubMed ID: 30030612
                SO-VID: 516a7cf8-bad5-4fb2-bb62-70b64b80af16
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 22 September 2017
                Funding
                Funded by: National Natural Science Foundation of China (CN)
                Award ID: 81573245
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81102198
                Award Recipient :
                Funded by: Shanxi provincial health and Family Planning Commission projects
                Award ID: 2014169
                Award Recipient :
                Categories
                Subject: Knee Arthroplasty
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2018

                ScienceOpen disciplines: Orthopedics
                Keywords: lateral-wedge insoles,medial knee osteoarthritis,meta-analysis
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: lateral-wedge insoles, medial knee osteoarthritis, meta-analysis

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