Clinical / Research

Gait Analysis and its Role in Transforming Knee Osteoarthritis Care

images-for-blogAs we are aware, Nova Scotia has the longest wait list for knee joint replacement in the country. The post entitled, “How long would you wait for your knee replacement” provides some pretty concerning facts about the state of this orthopaedic dilemma in Canada and in particular, here in Nova Scotia. Every day I speak to patients discouraged by the wait and frustrated by how little is offered to them in terms of conservative management. Additionally, the complex and multifactorial causes that lead to the development and progression of knee arthritis are difficult to assess and are not often addressed. Given that knee osteoarthritis (OA) is thought to be a disease resulting primarily from abnormal mechanics, there is a tremendous need to assess and treat these patient’s biomechanical impairments earlier in their continuum of care. This blog post raises awareness of the exciting knowledge gained through gait research and how we can apply it to this patient population.

Patients are becoming increasingly interested in learning about their alignment and muscle imbalances that may exist in their body. Many seek out objective and repeatable testing that they can use to help them in their struggle with pain and declining function. In the gait lab at the Clinical Research Validation Unit at the Nova Scotia Health Authority we use the EMOVI KneeKG to provide us with a 3-Dimensional knee kinematics (motion) assessment during treadmill walking. The individualized data and assessment is translated directly to the patient and clinician with guidance in gait modification and dynamic gait exercises that target dysfunction in the gait cycle.  In a recent abstract presented at the Congress of the Osteoarthritis Research Society International, authors found that 74% and 93% participants with knee OA who enrolled in the mykneeosteoarthritis.com program, which in part addressed abnormal gait biomechanics, improved at least one biomechanical gait marker linked to medial and patellofemoral knee OA respectively Therrien et al., (2016).  Interestingly, 7 out of 11 patients initially scheduled for a knee replacement postponed their surgery due to improvements.

Similarly, an abstract we presented at the Canadian Orthopaedic Association meetings in 2016, used the 3D kinematic gait assessments as a screening tool to classify candidates for surgical vs. non-surgical intervention. The data indicated that this assessment tool was successful as a predictive rule for surgical intervention (Dunbar et al., 2016).  As a result, a more streamlined approach for the evaluation for surgery for patients with knee osteoarthritis can be realized to potentially transform care pathways.

Moving towards providing patients and clinicians with objective gait data allows better education for the patient and in my experience, better compliance to a treatment program. Including physicians and surgeons in this knowledge base, combined with our ability to utilize new technologies to follow progression or regression can only aid in improved patient outcomes and possibly reduce wait times for our patients suffering from knee osteoarthritis.

 

This blog was written by physiotherapist, Hilary Macdonald. She is a graduate of Dalhousie’s School of Physiotherapy and has practiced as a clinician in the private and public sector for over 20 years. Her interest in improving care to those patients with osteoarthritis has led her to a position in orthopaedic research at the Nova Scotia Health Authority. The goal of the project she is working on is to leverage technology to improve the surgical referral and care processes for better patient outcomes and reduced wait times for surgery.

References:

Therrien, M., Fuentes, A., Landry, P., ElHachem, C., & Pontbriand, R. (2016). Real-world clinical result from a multimodal management program for knee osteoarthritis. Osteoarthritis and Cartilage, 24, S431.

Dunbar, M., Mezghani, N., Ouakrim, Y., Fuentes, A., Macdonald, H., Whynot, S., & Richardson, G. (2016, June).  Objective classification of surgical and non- surgical candidates for arthroplasty using 3D knee kinematics. Poster presents at the annual conference of the Canadian Orthopaedic Association, Quebec City, QC.

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2 thoughts on “Gait Analysis and its Role in Transforming Knee Osteoarthritis Care

  1. Interesting article as here in the Yukon we also have fairly substantial wait times. I wonder if you have any suggestions coming out of your research that would apply to the clinician without access to the hardware described in the article?

    • Great Question! we also have the surgeon fill out an appropriateness for surgery questionnaire based on Gillian Hawker’s work (See recent article here). We are now looking at how these results fit into our decision tree for yes/no to surgery. There are so many factors affecting wait times for orthopedic surgery and Nova Scotia is certainly struggling to make national benchmarks. We have updated the abstract on this post to include the poster that was presented at the Canadian Orthopaedic Association Meeting.

      We, along with others in the literature, have found some key metrics that are often visible clinically. These include the presence or absence of varus thrust, the ability to extend the knee during terminal stance (see previous blog post for an exercise to help this), and whether there is effusion or not. Of course there are many aspects that are not visible clinically, including moments (i.e. Adduction Moment) which would provide an indication of how much loading is occurring in the knee and also the electromyography which provides objective information on how the body is responding to knee OA and also has implications for progression given the level and duration of muscle activation can change joint loading. Hope this helps!

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