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A quantitative assessment of varus thrust during walking in women with early and established medial knee osteoarthritis
Abstract   Peer reviewed

A quantitative assessment of varus thrust during walking in women with early and established medial knee osteoarthritis

A. Mahmoudian, F.P. Luyten, I. Jonkers, J.H. van Dieën, S.M. Bruijm, I.A. Baert, G.S. Faber and S.M. Verschueren
Osteoarthritis and Cartilage, Vol.23
Seattle, Washington, USA, 04/2015
04/2015

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Abstract

Purpose: Varus thrust, known as an abrupt worsening of the existing varus during weight-bearing, has been shown to be present in patients with severe knee osteoarthritis (OA) and is considered as one of the risk factors for the incidence and progression of symptomatic medial knee OA. However, the association of varus thrust with increased severity of knee OA has not been studied yet. Therefore, this study compared the varus thrust during gait between patients with early medial knee OA, established OA and healthy controls. We were also interested to investigate the impact of the presence of varus thrust at baseline on functional decline and clinical worsening of the symptoms in women with medial knee OA at a 2-years follow up. Methods: Eighteen women with early medial knee OA (according to the classification of Luyten et al), sixteen women with established medial knee OA and sixteen healthy controls were evaluated. At baseline and at two-year follow-up, pain, symptoms, and subjective functional ability were assessed using the Knee Injury and Osteoarthritis Outcome Score questionnaire, and objective functional ability was assessed using the Timed Up & Go test (TUG) and the Stair Climbing Test (SCT). In addition, varus thrust was measured by 3D motion analysis of normal gait at preferred speed, as an increase of the knee varus angle during the weight-bearing phase of gait. Results: Both early and established OA groups reported significantly more knee pain and symptoms and worse functional ability compared to controls at baseline and also at two-year follow-up. However, none of the objective functional measures (SCT and TUG) were significantly different between the three groups. Varus thrust was significantly higher in both early and established OA subjects compared to the control group (p <0.001 and p =0.003, respectively). In addition, the amount of varus thrust at baseline was significantly correlated with functional objective measures at follow-up (pTUG=0.010, pSCT=0.023). Moreover, baseline varus thrust was also significantly correlated with pain (pBaseline<0.001, pFollow-up=0.004), symptoms (pBaseline=0.008, pFollow-up=0.047) and ADL (pBaseline<0.001, pFollow-up<0.001) at both baseline and follow-up. Conclusions: Higher values of varus thrust were found both in early and established stages of OA, suggesting that problems with dynamic stabilization of the knee are present already in the very beginning of knee OA, suggesting that varus thrust is probably not a result of disease progression. Varus thrust at baseline was related with poor subjective (ADL) and objective (SCT and TUG) physical function at two-year follow up, which may imply that varus thrust is a problem that has to be addressed in rehabilitation program.

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