HSS Journal

, Volume 8, Issue 1, pp 45–48

Gait Modification to Treat Knee Osteoarthritis

HSS Osteoarthritis Symposium: Frontiers in OA


knee osteoarthritis gait modification knee adduction moment medial contact force 


  1. 1.
    Andriacchi TP. Dynamics of knee malalignment. Orthopedic Clinics of North America. 1994;25:395–403.PubMedGoogle Scholar
  2. 2.
    Barrios JA, Crossley KM, Davis IS. Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment. Journal of Biomechanics. 2010;43:2208–2213.PubMedCrossRefGoogle Scholar
  3. 3.
    Block JA, Shakoor N. Lower limb osteoarthritis: biomechanical alterations and implications for therapy. Current Opinion in Rheumatology. 2010;22:544–550.PubMedCrossRefGoogle Scholar
  4. 4.
    Butler RJ, Marchesi S, Royer T, Davis IS. The effect of a subject-specific amount of lateral wedge on knee mechanics in patients with medial knee osteoarthritis. Journal of Orthopaedic Research. 2007;25:1121–1127.PubMedCrossRefGoogle Scholar
  5. 5.
    Creaby MW, Wang Y, Bennell KL, Hinman RS, Metcalf BR, Bowles KA, Cicuttini FM. Dynamic knee loading is related to cartilage defects and tibial plateau bone area in medial knee osteoarthritis. Osteoarthritis and Cartilage. 2010;18:1380–1385.PubMedCrossRefGoogle Scholar
  6. 6.
    Dowling AV, Fisher DS, Andriacchi TP. Gait modification via verbal instruction and an active feedback system to reduce peak knee adduction moment. Journal of Biomechanical Engineering. 2010;132:071007.PubMedCrossRefGoogle Scholar
  7. 7.
    Draganich L, Reider B, Rimington T, Piotrowski G, Mallik K, Nasson S. The effectiveness of self-adjustable custom and off-the-shelf bracing in the treatment of varus gonarthrosis. Journal of Bone and Joint Surgery (American). 2006;88:2645–2652.CrossRefGoogle Scholar
  8. 8.
    Erhart JC, Dyrby CO, D’Lima DD, Colwell CW, Andriacchi TP. Changes in in vivo knee loading with a variable-stiffness intervention shoe correlate with changes in the knee adduction moment. Journal of Orthopaedic Research. 2010;28:1548–1553.PubMedCrossRefGoogle Scholar
  9. 9.
    Erhart JC, Mundermann A, Elspas B, Giori NJ, Andriacchi TP. A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis. Journal of Biomechanics. 2008;41:2720–2725.PubMedCrossRefGoogle Scholar
  10. 10.
    Foroughi N, Smith R, Vanwanseele B. The association of external knee adduction moment with biomechanical variables in osteoarthritis: a systematic review. Knee. 2009;16:303–309.PubMedCrossRefGoogle Scholar
  11. 11.
    Fregly BJ, Chmielewski TL, Walter JP, Pun H, Chan NK, Moser MW, Vincent KR. Evaluation of a model-based gait retraining method for knee osteoarthritis rehabilitation. Gait & Clinical Movement Analysis Soceity Annual Conference. 2011;369–370.Google Scholar
  12. 12.
    Fregly BJ, D’Lima DD, Colwell CW. Effective gait patterns for offloading the medial compartment of the knee. Journal of Orthopaedic Research. 2009;27:1016–1021.PubMedCrossRefGoogle Scholar
  13. 13.
    Fregly BJ, Reinbolt JA, Chmielewski TL. Evaluation of a patient-specific cost function to predict the influence of foot path on the knee adduction torque during gait. Computer Methods in Biomechanics and Biomedical Engineering. 2008;11:63–71.PubMedCrossRefGoogle Scholar
  14. 14.
    Fregly BJ, Reinbolt JA, Rooney KL, Mitchell KH, Chmielewski TL. Design of patient-specific gait modifications for knee osteoarthritis rehabilitation. IEEE Transactions on Biomedical Engineering. 2007;54:1687–1695.PubMedCrossRefGoogle Scholar
  15. 15.
    Guo M, Axe MJ, Manal K. The influence of foot progression angle on the knee adduction moment during walking and stair climbing in pain free individuals with knee osteoarthritis. Gait and Posture. 2007;26:436–441.PubMedCrossRefGoogle Scholar
  16. 16.
    Hinman RS, Bennell KL. Advances in insoles and shoes for knee osteoarthritis. Current Opinions in Rheumatology. 2009;21:164–170.CrossRefGoogle Scholar
  17. 17.
    Hunt MA, Birmingham TB, Bryant D, Jones I, Giffin JR, Jenkyn TR, Vandervoort AA. Lateral trunk lean explains variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis. Osteoarthritis and Cartilage. 2008;16:591–599.PubMedCrossRefGoogle Scholar
  18. 18.
    Hunt MA, Simic M, Hinman RS, Bennell KL, Wrigley TV. Feasibility of a gait retraining strategy for reducing knee joint loading: increased trunk lean guided by real-time biofeedback. Journal of Biomechanics. 2011;44:943–947.PubMedCrossRefGoogle Scholar
  19. 19.
    Hurwitz DE, Ryals AB, Case JP, Block JA, Andriacchi TP. The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. Journal of Orthopaedic Research. 2002;20:101–107.PubMedCrossRefGoogle Scholar
  20. 20.
    Kakihana W, Akai M, Nakazawa K, Takashima T, Naito K, Torii S. Effects of laterally wedged insoles on knee and subtalar joint moments. Archives of Physical Medicine and Rehabilitation. 2005;86:1465–1471.PubMedCrossRefGoogle Scholar
  21. 21.
    Kemp G, Crossley KM, Wrigley TV, Metcalf BR, Hinman RS. Reducing joint loading in medial knee osteoarthritis: shoes and canes. Arthritis & Rheumatism. 2008;59:609–614.CrossRefGoogle Scholar
  22. 22.
    Kuroyanagi Y, Nagura T, Matsumoto H, Otani T, Suda Y, Nakamura T, Toyama Y. The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis. Osteoarthritis and Cartilage. 2007;15:932–936.PubMedCrossRefGoogle Scholar
  23. 23.
    Kutzner I, Damm P, Heinlein B, Dymke J, Graichen F, Bergmann G. The effect of laterally wedged shoes on the loading of the medial knee compartment-in vivo measurements with instrumented knee implants. Journal of Orthopaedic Research. 2011:(in press).Google Scholar
  24. 24.
    Kutzner I, Kuther S, Heinlein B, Dymke J, Bender A, Halder AM, Bergmann G. The effect of valgus braces on medial compartment load of the knee joint—in vivo load measurements in three subjects. Journal of Biomechanics. 2011;44:1354–1360.PubMedCrossRefGoogle Scholar
  25. 25.
    Lindenfeld TN, Hewett TE, Andriacchi TP. Joint loading with valgus bracing in patients with varus gonarthrosis. Clinical Orthopaedics and Related Research. 1997;344:290–297.PubMedCrossRefGoogle Scholar
  26. 26.
    Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Annals of the Rheumatic Diseases. 2002;61:617–622.PubMedCrossRefGoogle Scholar
  27. 27.
    Mündermann A, Asay JL, Mündermann L, Andriacchi TP. Implications of increased medio-lateral trunk sway for ambulatory mechanics. Journal of Biomechanics. 2008;41:165–170.PubMedCrossRefGoogle Scholar
  28. 28.
    Mündermann A, Dyrby CO, Hurwitz DE, Sharma L, Andriacchi TP. Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity. Arthritis & Rheumatism. 2004;50:1172–1178.CrossRefGoogle Scholar
  29. 29.
    Reeves ND, Bowling FL. Conservative biomechanical strategies for knee osteoarthritis. Natural Reviews. Rheumatology. 2011;7:113–122.CrossRefGoogle Scholar
  30. 30.
    Robbins SM, Maly MR. The effect of gait speed on the knee adduction moment depends on waveform summary measures. Gait & Posture. 2009;30:543–546.CrossRefGoogle Scholar
  31. 31.
    Schache AG, Fregly BJ, Crossley KM, Hinman RS, Pandy MG. The effect of gait modification on the external knee adductor moment is reference frame dependent. Clinical Biomechanics. 2008;23:601–608.PubMedCrossRefGoogle Scholar
  32. 32.
    Shakoor N, Lidtke RH, Sengupta M, Fogg LF, Block JA. Effects of specialized footwear on joint loads in osteoarthritis of the knee. Arthritis & Rheumatism. 2008;59:1214–1220.CrossRefGoogle Scholar
  33. 33.
    Sharma L, Hurwitz DE, Thonar EJ-MA, Sum JA, Lenz ME, Dunlop DD, Schnitzer TJ, Kirwan-Mellis G, Andriacchi TP. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis & Rheumatism. 1998;41:1233–1240.CrossRefGoogle Scholar
  34. 34.
    Shull PB, Lurie KL, Cutkosky MR, Besier TF. Training multi-parameter gaits to reduce the knee adduction moment with data-driven models and haptic feedback. Journal of Biomechanics. 2011;44:1605–1609.PubMedCrossRefGoogle Scholar
  35. 35.
    Simic M, Hinman RS, Wrigley TV, Bennell KL, Hunt MA. Gait modification strategies for altering medial knee joint load: a systematic review. Arthritis Care & Research. 2011;63:405–426.Google Scholar
  36. 36.
    Tate JJ, Milner CE. Real-time kinematic, temporospatial, and kinetic biofeedback during gait retraining in patients: a systematic review. Physical Therapy. 2010;90:1123–1134.PubMedCrossRefGoogle Scholar
  37. 37.
    Thorp LE, Sumner DR, Block JA, Moisio KC, Shott S, Wimmer MA. Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. Arthritis and Rheumatism. 2006;54:3842–3849.PubMedCrossRefGoogle Scholar
  38. 38.
    Thorp LE, Sumner DR, Wimmer MA, Block JA. Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis. Arthritis & Rheumatism. 2007;57:1254–1260.CrossRefGoogle Scholar
  39. 39.
    Toriyama M, Deie M, Shimada N, et al. Effects of unloading bracing on knee and hip joints for patients with medial compartment knee osteoarthritis. Clinical Biomechanics. 2011;26:497–503.PubMedCrossRefGoogle Scholar
  40. 40.
    Wada M, Imura S, Nagatani K, Baba H, Shimada S, Sasaki S. Relationship between gait and clinical results after high tibial osteotomy. Clinical Orthopaedics and Related Research. 1998;354:180–188.PubMedCrossRefGoogle Scholar
  41. 41.
    Walter JP, D’Lima DD, Colwell CW, Fregly BJ. Decreased knee adduction moment does not guarantee decreased medial contact force during gait. Journal of Orthopaedic Research. 2010;28:1348–1354.PubMedCrossRefGoogle Scholar
  42. 42.
    Wheeler JW, Shull PB, Besier TF. Real-time knee adduction moment feedback for gait retraining through visual and tactile displays. Journal of Biomechanical Engineering. 2011;133:041007.PubMedCrossRefGoogle Scholar
  43. 43.
    Zhao D, Banks SA, Mitchell KH, D'Lima DD, Colwell CW, Fregly BJ. Correlation between the knee adduction torque and medial contact force for a variety of gait patterns. Journal of Orthopaedic Research. 2007;25:789–797.PubMedCrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2011

Authors and Affiliations

  1. 1.Department of Mechanical and Aerospace EngineeringUniversity of FloridaGainesvilleUSA

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