[Effect of bone-setting manipulation on lower extremity alignment in patients with varus knee osteoarthritis].

Objective: To observe the effect of bone setting manipulation on the lower limb alignment in patients with varus knee osteoarthritis (KOA), and to elucidate the underlying therapeutic mechanism.

Methods: A total of 100 patients with KOA who received bone-setting manipulation between October 2022 and October 2023 were enrolled. Among them, there were 24 males and 76 females, the age ranged from 47 to 75 years with a mean age of (62.9±8.2) years and a disease course ranging from 0.25 to 20 years . All patients were treated with bone-setting manipulation on spine, hip joint, knee joint, and ankle joint.The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was adopted to evaluate knee joint function. Full-length weight-bearing X-rays of both lower extremities were performed on each patient before treatment and 2 weeks after treatment. The changes in the hip-knee-ankle (HKA) angle of both lower extremities at 2 weeks after treatment compared with those before treatment, as well as the changes in the gap between the HKA angles of both lower extremities before treatment and 2 weeks after treatment, were observed and recorded.

Results: A total of 89 patients were followed up at 2 weeks after treatment. The WOMAC score at 2 weeks after treatment was 23.0 (15.0, 31.0), which was lower than the preoperative score of 42.0 (34.3, 49.0), and the difference was statistically significant (P<0.001). There was no statistically significant difference in the HKA angles of the unaffected and affected sides between before treatment and 2 weeks after treatment(P>0.05). However, the absolute value of the HKA angle difference between the unaffected and affected sides at 2 weeks after treatment was 1.8 (0.8, 3.2)°, which was lower than that before treatment 2.1(1.0, 3.5)°, and the difference was statistically significant (P<0.05).

Conclusion: Bone-setting manipulation is effective in reducing pain, stiffness, and improving joint function in patients with KOA. The therapeutic mechanism may be due to the correction of the subtle dislocation across the spine, hip, knee, and ankle, thereby reducing bilateral lower limb mechanical axis discrepancies and balancing weight distribution across both knee joints.