Reducing post-operative knee flexion contracture recurrence by correcting leg length discrepancy in the non-surgical knee in patients undergoing total knee arthroplasty for primary osteoarthiritis - a feasibility study
Mental Health, Children and Community Care
BAM-16-001 Integration of leg length discrepancy (LLD) correction using a shoe lift as part of the treatment of knee osteoarthritis (OA) and joint replacement to improve outcomes post-total knee arthroplasty (TKA). Adoptability : Screening for LLD can easily be done at the bedside with basic equipment, at minimal cost. A shoe lift is an inexpensive device that can be constructed at most Canadian health care institutions. The application of a shoe lift post-TKA to correct a LLD could be smoothly integrated into hospital care pathways. Outcomes: Reduced pain, stiffness and function following LLD correction post-TKA in patients with OA.
BAM-16-001 Background: Osteoarthritis (OA) affects >½ the population >65, contributing to escalating healthcare costs. Knee OA patients often develop a knee flexion contracture (FC), which may result in a leg length discrepancy (LLD) that amplifies joint symptoms. An LLD can be corrected by a shoe lift but this is not standard of care for OA patients. Those presenting for TKA with bilateral pre-op FC will have a resulting post-op LLD when extension is restored to one knee. Hypotheses: (1) Knee FC is common in OA patients, associated with worse pain, stiffness, function and LLD, (2) LLD correction with a shoe lift reduces OA symptoms, (3) Post-TKA LLD correction improves patient outcomes. Methods: Multi-design: (1) Cross-sectional database analysis using the osteoarthritis initiative (OAI, n=4796) evaluating knee FC association with WOMAC pain, stiffness and function, (2) measurement of LLD associated with knee FC in OA patients presenting for TKA, (3) systematic review evaluating methods of correcting LLD in OA setting, (4) development of a placebo shoe lift for LLD-correcting clinical trials, and (5) a randomized double-blind placebo-controlled trial evaluating post-operative LLD correction in patients with bilateral pre-operative knee FC. Results: 1/3 of OAI participants had a knee FC, associated with worse pain, stiffness and function (p<0.001 for each vs no FC). All patients that presented for TKA with a unilateral FC had a LLD (p<0.001). A shoe lift safely corrected LLD, but optimal correction strategies are unclear. Our placebo shoe lift is in use in our ongoing clinical trial. Conclusions: Knee FC is common in OA patients, associated with worse pain, stiffness, function and LLD. LLD correction reduces pain in OA, is safe and inexpensive, and can be done in most Canadian healthcare institutions.