Advertisement

Changes in knee moments with contralateral versus ipsilateral cane usage in females with knee osteoarthritis

      Abstract

      Background. Conservative treatment for osteoarthritis often involves educating the patient in methods of decreasing the load transmitted through the diseased joint. The use of a cane is one such method and the correct placement of the cane with respect to an abnormal knee joint is crucial. The purpose of this study was to compare effects on knee moments of force of contralateral versus ipsilateral cane usage in female subjects with osteoarthritic knees.
      Methods. A convenience sample of 14 subjects volunteered for this study. Subjects walked over force platforms while ground reaction force and three-dimensional kinematic data were captured using a Vicon 370 System. The subjects were tested walking: (a) unaided, (b) with ipsilateral cane, and (c) with contralateral cane. Inverse dynamics were employed to calculate temporal–spatial, kinematic and kinetic variables. Dependent variables included hip and knee frontal plane and sagittal plane moments of force, walking speed, cadence and stride length. Repeated measures ANOVA assessed differences among walking conditions.
      Findings. Subjects walked significantly faster in the unaided gait condition owing to a higher cadence. Ipsilateral cane use resulted in significantly larger hip (versus contralateral P = 0.018; versus unaided P = 0.036) and knee (versus contralateral P = 0.043; versus unaided P = 0.030) frontal plane peak moments during gait. Contralateral cane placement was associated with the smallest peak knee abductor (P = <0.001) and flexor (P = <0.001) moments. Knee deformity (varus or valgus) did not have any significant effect on any variable possibly due to small sample size.
      Interpretation. The results suggest that as is the case for the hip contralateral cane placement is the most efficacious for persons with knee osteoarthritis. In fact, no cane use may be preferable to ipsilateral cane usage as the latter resulted in the highest knee moments of force, a situation which may exacerbate pain and deformity.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Altman R.D.
        • Asch E.
        • Bloch D.
        Development of criteria for the classification and reporting of osteoarthritis of the knee.
        Arthritis Rheum. 1986; 29: 1039-1049
        • Andriacchi T.P.
        • Andersson G.B.J.
        • Ortengren R.
        • Mikosz R.P.
        A study of factors influencing muscle activity about the knee joint.
        J. Orthop. Res. 1984; 1: 266-275
        • Blount W.P.
        Don’t throw away the cane.
        J. Bone Joint Surg. 1956; 38A: 695-708
        • Bruns J.
        • Volkmer M.
        • Luessenhop S.
        Pressure distribution at the knee joint—Influence of varus and valgus deviation without and with ligament dissection.
        Arch. Orthop Trauma Surg. 1993; 133: 12-19
        • Davis III, R.B.
        • et al.
        A gait data collection and reduction technique.
        Hum. Mov. Sci. 1991; 10: 575-587
        • Edwards B.G.
        Contralateral and ipsilateral cane usage by patients with total knee or hip replacement.
        Arch. Phys. Med. Rehabil. 1986; 67: 734-740
        • Gerber L.H.
        • Hicks J.E.
        Rehabilitation in the management of patients with osteoarthritis.
        in: Moskowita R.W. Howell D.S. Goldberg V.M. Mankin H.J. Osteoarthritis—Diagnosis & Management. W.B. Saunders Company, Philadelphia1984: 287-315
        • Gok H.
        • et al.
        Kinetic and kinematic characteristics of gait in patients with medial knee arthrosis.
        Acta Orthopaed. Scand. 2002; 73: 647-652
        • Harrington J.J.
        A bioengineering analysis of force actions at the knee in normal and pathologic gait.
        Biomed. Eng. 1976; 11: 167-172
        • Harrington J.J.
        Static and dynamic loading patterns in knee joints with deformities.
        J. Bone Joint Surg. 1983; 65A: 247-259
        • Holden J.P.
        • Stanhope S.J.
        The effect of variation in knee center location estimates on net knee joint moments.
        Gait Posture. 1998; 7: 1-6
        • Hurwitz D.
        • et al.
        Gait compensations in patients with osteoarthritis of the hip and their relationship with pain and passive hip motion.
        J. Orthop. Res. 1997; 15: 629-635
      1. Hurwitz, D., 1998. Dynamic knee loads during gait predict proximal tibial bone distribution

        • Hurwitz D.
        • et al.
        Effect of knee pain on joint loading in patients with osteoarthritis.
        Curr. Opin. Rheum. 1999; 11: 422-426
        • Hurwitz D.
        • et al.
        Knee pain and joint loading in subjects with osteoarthritis of the knee.
        J. Orthop. Res. 2000; 18: 572-579
        • Johnson F.
        • et al.
        The distribution of load across the knee: A comparison of static and dynamic measurements.
        J. Bone Joint Surg. 1980; 62: 346-349
        • Kettelkamp D.
        • Chao E.
        A method for quantitative analysis of medial and lateral compression forces at the knee during standing.
        Clin. Orthop. Rel. Res. 1972; 83: 203-213
        • Leon H.O.
        • et al.
        Arthroscopic decompressive medial release of the varus arthritic knee: expanding the functional envelope.
        Arthroscopy. 2001; 17: 523-526
        • Lequesne M.
        • et al.
        Indices of severity for osteoarthritis of the hip and knee.
        Scand. J. Rheumatol. 1987; 65: 85-89
        • Maly M.R.
        • et al.
        Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis.
        Clin. Biomech. 2002; 17: 603-610
        • March L.
        • Schwarz J.
        Risk factors for osteoarthritis: A population survey among 45–65 year olds in urban Australia.
        Osteoarthr. Cartilage. 1994; 2: 41
        • Mendelson S.
        • et al.
        Effect of cane use on tibial strain and strain rates.
        Am. J. Phys. Med. Rehabil. 1998; 77: 333-338
        • Morrison J.B.
        The mechanics of the knee joint in relation to normal walking.
        J. Biomech. 1970; 2: 51-61
        • Mulley G.P.
        Walking sticks.
        Br. Med. J. 1988; 296: 475-476
        • Murray M.P.
        • et al.
        A survey of the time, magnitude and orientation of forces applied to walking sticks by disabled men.
        Am. J. Phys. Med. 1969; 48: 1-13
        • Neumann D.A.
        Hip abductor muscle activity as subjects with hip prostheses walk with different methods of using a cane.
        Phys. Ther. 1998; 78: 490-501
        • Olmstead T.G.
        • et al.
        Effect of muscular activity on valgus/varus laxity and stiffness of the knee.
        J. Biomech. 1986; 19: 565-577
        • Rejeski W.J.
        • et al.
        The evaluation of pain in patients with osteoarthritis: The knee pain scale.
        J. Rheumatol. 1995; 22: 1124-1129
        • Riegger-Krugh C.
        • et al.
        Tibiofemoral contact pressures in degenerative joint disease.
        Clin. Orthopaed. Relat. Res. 1998; 348: 233-245
        • Schipplein O.D.
        • Andriacchi T.P.
        Interaction between active and passive knee stabilizers during level walking.
        J. Orthop. Res. 1991; 9: 113-119
        • Sharma L.
        • et al.
        Knee adduction moment, serum hyaluronan level and disease severity in medial tibiofemoral osteoarthritis.
        Arthritis Rheum. 1998; 41: 1233-1240
        • Van der Esch M.
        • et al.
        Factors contributing to possession and use of walking aids among persons with rheumatoid arthritis and osteoarthritis.
        Arthritis Rheum. 2003; 49: 838-842
        • Vargo M.M.
        • et al.
        Contralateral V ipsilateral cane use—Effects on muscles crossing the knee joint.
        Am. J. Phys. Med. Rehabil. 1992; 71: 170-176
        • Winter D.A.
        Overall principle of lower limb support during stance phase of gait.
        J. Biomech. 1980; 13: 923-927
        • Winter D.A.
        Kinematics and kinetic patterns in human gait: variability and compensating effects.
        Hum. Mov. Sci. 1984; 3: 51-76