The use of nails or insoles in combination with non-biomechanical treatments appears to provide the greatest pain relief in patients with medial tibiofemoral osteoarthritis, although the evidence supporting these interventions has a high degree of uncertainty, according to the results of a large meta-analysis of randomized controlled trials presented at the OARSI 2021 World Congress.
“For several years now, it has been emphasized that, due to the high rate of joint replacement, we need to promote more effective non-surgical treatments.” Ans van Ginckel, doctor, from the University of Ghent (Belgium), told the conference.
However, guidelines on the use of biomechanical treatments for knee OA pain vary widely, and there are few studies comparing the effectiveness of different interventions.
To address this, van Ginckel and his colleagues made one network meta-analysis of 27 randomized and controlled trials (with a total of 2,413 participants) of biomechanical treatments for knee AO pain. The treatments included were valgus nails, combined nail treatment (with added non-biomechanical treatment), lateral or medial wedge insoles, combined template treatment (with added non-biomechanical treatment), use of contralateral cane, gait recycling and shoes modified.
“These treatments are based primarily on the premise that people with knee osteoarthritis are likely to experience a higher external knee adduction moment while walking, compared to healthy people,” van Ginckel said at the conference, sponsored by the Osteoarthritis Research Society International. “This has been associated to some extent with the onset, severity, and progression of the disease.”
Compared with non-biomechanical controls, canes and canes were the only intervention that showed a benefit in pain reduction, although the authors described the data supporting this as “high risk”.
When all treatments were classified according to the degree of pain relief seen in the studies, the combined staff and / or combined apparatus treatments showed the highest degree of benefit.
However, van Ginckel said the evidence supporting even these treatments was of low to very low certainty, there were significant variations in the control treatments used in the studies and the confidence intervals were wide. This also reflected the multifactorial nature of pain in the OA genome, he said.
“A plausible explanation is the partial role in biomechanics of pain pathogenesis and the multifactorial nature of pain,” he said.
Commenting on the study, Rik Lories, MD, PhD, head of the rheumatology division of the University of Hospitals of Leuven (Belgium) and the department of development and regeneration of the Catholic University of Leuven, said that the conclusions of the analysis show how difficult it is to study biomechanical interventions for in the OA of the knee.
“It was a smart approach to try to get more information about a wide range of studies that have been done, being selective as to what should be included,” Lories said. “It’s still a big challenge in terms of how you control the confounders.”
Lories said he had a positive view of the findings, suggesting that these interventions are unlikely to cause harm and therefore “are not a way to avoid” to help reduce OA knee pain. But he also argued that the analysis pointed to a clear need for better biomechanical intervention studies for knee OA. “I think it’s an important message that somehow the field needs to improve the quality of its trials,” he said in an interview, though he acknowledged that such trials can be difficult to execute and obtain funding.
Van Ginckel received support from an EU Horizon 2020 grant and a co-author received support from the Australian National Council for Health and Medical Research. No conflicts of interest were declared.
This article originally appeared on MDedge.com, which is part of the Medscape professional network.
