Background: The annual demand for total knee arthroplasty (TKA) will increase by 182%, from more than 700,000 in 2014 to 1.2M in the year 2030, placing an immense financial and social burden on healthcare systems to control medical costs and quality of care. This study aimed to examine the long-term effect of a home-based, non-surgical biomechanical intervention on surgery incidence amongst patients with moderate-severe knee osteoarthritis (OA). Methods: This is a retrospective registry review done at the Department of Rehabilitation Medicine of Albert Einstein College of Medicine, Montefiore Medical Center. Between September 2015 and December 2018, 95 patients (81% females, mean age 62.6± 8.3 years) diagnosed with primary knee OA were referred to receive a new non-invasive biomechanical foot-worn device after exhausting other non-surgical care. Patients were personally fitted with a non-invasive, biomechanical device, that alters the foot’s pressure points to reduce loads, minimize symptoms, and promote neuromuscular control training using adjustable, convex pods under the sole. Patients used the device for short periods during regular home/work activities. The primary outcome was the occurrence of knee surgery during an average follow-up time of 5.6 years. TKA incidence was compared to that of a reference group of patients with knee OA who were referred to receive traditional physical therapy (PT). Results: Of the patients who were treated with the biomechanical intervention, 12/95 patients (12.6%) had a TKA, compared to 23/67 patients (34.3%) who received traditional PT and had a TKA. Conclusion: The use of the biomechanical intervention was associated with avoiding TKA in more than 87% of patients at five years. Increased use of biomechanical intervention to treat knee OA may help reduce some of the burden on healthcare and society associated with end-stage knee OA by delaying or avoiding surgery.

OBJECTIVES:To evaluate kinematic and kinetic parameters for high school (HS) and professional (PRO) pitchers differentiated by stride width. DESIGN:Descriptive laboratory study. METHODS:HS (n = 36) and PRO (n = 172) baseball pitchers pitched 8-12 fastballs using 3D-motion capture (480-Hz). Pitchers were 1:1 propensity-scored matched by age, height, weight, and ball velocity based on 'narrow' versus 'wide' stride widths and kinematics and kinetics were compared using independent t-tests. Independent associations between variables and stride width were determined utilizing linear regressions. RESULTS:At foot contact, HS wide (n = 18) had significantly less lead knee flexion (41 ± 9° vs. 49 ± 6°, p = 0.007, d = -1.0) and less pelvis rotation (66 ± 9° vs. 57 ± 14°, p = 0.003 d = 0.8) compared to HS narrow (n = 18). PRO wide (n = 86) at ball release had significantly less pelvis rotation (-10 ± 10° vs. -15 ± 14°, p = 0.008, d = 0.4) and increased shoulder horizontal adduction (4±8° vs. -1±9°, p=0.003, d=0.5) compared to PRO narrow (n = 86). For every 10 cm increase in stride width, pelvis rotation at ball release decreased by 2° (B:0.10, β:0.20, p < 0.001) in HS and 1.3° (B:0.08, β:0.13, p = 0.002) in PRO. CONCLUSIONS:HS and PRO pitchers differentiated by stride width demonstrated no significant difference in throwing arm kinetics. For both groups, wider stride width was associated with decreased pelvis rotation, which may contribute to inefficient utilization of kinetic energy. Ultimately, coaches and players may better focus their efforts on refining other kinematics for enhanced performance outcomes and safe pitching mechanics.