Associations of varus thrust and alignment with pain in knee osteoarthritis


  • Grace H. Lo,

    Corresponding author
    1. Michael E. DeBakey VA Medical Center, Houston VA Health Services Research and Development Center of Excellence, and Baylor College of Medicine, Houston, Texas
    • Baylor College of Medicine, 1 Baylor Plaza, BCM-285, Houston, TX 77030
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  • William F. Harvey,

    1. Tufts Medical Center, Boston, Massachusetts
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    • Dr. Harvey has received honoraria from Vindico Medical Education (less than $10,000).

  • Timothy E. McAlindon

    1. Tufts Medical Center, Boston, Massachusetts
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    • Dr. McAlindon has received consulting fees, speaking fees, and/or honoraria from Flexion Therapeutics, URL Pharma, and Wintherix and Epitherix (less than $10,000 each); he holds a patent (US patent no. 7,251,609) for a method for conducting clinical trials over the Internet.

  • identifier: NCT00306774.

  • The views expressed herein are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.



To investigate associations of varus thrust and varus static alignment with pain in patients with knee osteoarthritis (OA).


This was a cross-sectional study of participants from a randomized controlled trial of vitamin D treatment for knee OA. Participants were video recorded while walking and scored for presence of varus thrust. Static alignment was measured on standard posteroanterior knee radiographs. Pain questions from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire were used to assess symptoms. We calculated means for total WOMAC pain in relation to varus thrust and static varus alignment (i.e., corrected anatomic alignment <178 degrees). Ordinal logistic regressions were performed, with responses on individual WOMAC pain questions as the outcomes and varus thrust and varus alignment as the predictors.


There were 82 participants, 60% of whom were female. The mean ± SD age was 65.1 ± 8.5 years, and the mean ± SD body mass index was 30.2 ± 5.4 kg/m2. The mean total WOMAC pain score was 6.3 versus 3.9, respectively, in those with versus without definite varus thrust (P = 0.007) and 5.0 versus 4.2 in those with versus without varus alignment (P = 0.36). Odds ratios for pain with walking and standing were 4.7 (95% confidence interval 1.8–11.9) and 5.5 (95% confidence interval 2.2–14.2), respectively, in those with and those without definite varus thrust. There were no significant associations between varus alignment and responses to individual WOMAC pain questions. Sensitivity analyses suggested that varus classified using a more stringent definition might have been associated with pain on walking and standing.


In patients with knee OA, varus thrust, and possibly varus static alignment, were associated with pain, specifically during weight-bearing activities. Treatment of varus thrust (e.g., via bracing or gait modification) may lead to improvement of symptoms.