A biomechanical analysis of trunk and pelvis motion during gait in subjects with knee osteoarthritis compared to control subjects

104

Objective. To evaluate whether increased lateral trunk lean toward the symptomatic lower extremity during gait in people with medial knee osteoarthritis (OA) immediately alters symptoms or medial knee load, as measured by the external knee adduction moment (KAM). Methods. Participants with medial knee OA (n ‫؍‬ 22) underwent 3-dimensional gait analysis to measure KAM peaks (early and late stance) and KAM impulse. Following the analysis of natural gait, participants were trained to lean their trunk toward the symptomatic leg during ipsilateral stance over 3 randomly ordered conditions (6°, 9°, and 12°lean). A projection screen displayed real-time trunk angles and target levels. Pain/discomfort in the knees, the hip, and the back were measured across conditions. Load-modifying effects of increasing lean magnitudes were investigated using linear mixed models. Mediating effects of peak lean timing and participant characteristics (pain and malalignment) were evaluated. Results. Increased trunk lean reduced all KAM measures (P

Section: Discussionmentioning

confidence: 99%

Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles

Simić¹,

Hunt²,

Bennell³

et al. 2012

104

“…Hunt et al (16) support this, reporting smaller trunk lean angle in healthy adults compared to individuals with mild and moderate knee OA. Linley et al (20) also reported differences between patients with knee OA and healthy adults, although these differences were only apparent when using advanced statistical pattern recognition techniques. We are aware of only one study reporting the relationship between toe-out and trunk lean and pain.…”

Section: Introductionmentioning

confidence: 99%

“…We evaluated pain intensity in patients with knee OA over time using 1-factor repeated-measures analysis of variance (ANOVA). We compared toe-out, trunk lean, and pelvic obliquity between groups (patients with knee OA versus healthy controls) and over time (5,10,15,20,25, and 30 minutes) using 2-factor repeated-measures ANOVAs. In the event of a significant main effect or interaction, Scheffe's post hoc tests were planned.…”

Section: Significance and Innovationsmentioning

confidence: 99%

“…Gait compensations can be described as the tendency of patients to compensate for localized pain and pathology by adopting probable automatic gait modifications (6). Gait patterns that alter knee joint loads or are related to pain have recently engendered particular interest, especially toe-out angle (7)(8)(9)(10)(11)(12)(13), trunk lean toward the stance leg (14 -19), and associated pelvic obliquity (15,16,20). These gait patterns are correlated with the external knee adduction moment about the knee (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

“…The role of pelvic obliquity in patients with knee OA has also gained recent attention. Although it is not shown to be a direct compensatory mechanism, pelvic obliquity has been discussed as a contributor to lateral trunk lean (15)(16)(17)20).…”

Section: Introductionmentioning

confidence: 99%

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Toe‐out, lateral trunk lean, and pelvic obliquity during prolonged walking in patients with medial compartment knee osteoarthritis and healthy controls

Bechard

Birmingham

Zečević

et al. 2012

Objective. To compare the time-varying behavior of maximum toe-out angle, lateral trunk lean (over the stance leg), and pelvic obliquity (rise and drop on the swing leg) during prolonged walking in participants with and without medial compartment knee osteoarthritis (OA), and to explore correlations between these gait characteristics and pain. Methods. Twenty patients with knee OA and 20 healthy controls completed 30 minutes of treadmill walking. Toe-out, trunk lean, pelvic obliquity, and pain were measured at 5-minute intervals. Results. The mean ؎ SD toe-out angle was significantly smaller (P ‫؍‬ 0.04) in patients with knee OA (6.7 ؎ 2.5 degrees) than in controls (10.3 ؎ 2.2 degrees). Toe-out changed significantly over time (P ‫؍‬ 0.002), but not in a systematic way, and there was no interaction between group and time. The mean ؎ SD trunk lean was higher (P ‫؍‬ 0.03) in patients with knee OA (2.0 ؎ 1.0 degrees) than in controls (0.7 ؎ 0.5 degrees). Trunk lean did not change over time and there was no interaction between group and time. There were no differences for pelvic drop. The mean ؎ SD pelvic rise was higher (P ‫؍‬ 0.01) in patients with knee OA (2.8 ؎ 0.9 degrees) than in controls (1.2 ؎ 0.8 degrees), but did not change over time and there was no interaction. Patients experienced a small increase in pain (P < 0.001). Trunk lean and pelvic drop were correlated with pain (r ‫؍‬ 0.49, P ‫؍‬ 0.03 and r ‫؍‬ 0.47, P ‫؍‬ 0.04, respectively). Conclusion. Toe-out and trunk lean are consistently different between individuals with and without medial compartment knee OA during prolonged walking, and patients with greater pain have greater trunk lean. However, over 30 minutes of walking, these gait characteristics remain quite stable, suggesting they are not acute compensatory mechanisms in response to repetitive loading with subtle increases in pain.

Biomechanical Deviations During Level Walking Associated With Knee Osteoarthritis: A Systematic Review and Meta‐Analysis

Mills

Hunt

Ferber

2013

177

117

Objective. To identify which gait deviations are consistently associated with knee osteoarthritis (KOA) and how these are influenced by disease severity, the involved compartment, and sex. Methods. Five electronic databases and reference lists of publications were searched. Cross-sectional, observational studies comparing temporospatial variables, joint kinematics, and joint moments between individuals with KOA and healthy controls or between KOA subgroups were considered for review. Only publications scoring >50% on a modified methodology quality index were included. Because of the number of gait deviations examined, only biomechanical variables reported by >4 publications were further analyzed. Where possible, a meta-analysis was performed using effect sizes (ES) calculated from discrete variables. Results. In total, 41 publications examining 20 variables were included. The majority of consistent gait deviations associated with KOA were exhibited by those with severe disease in the temporospatial domain. Individuals with severe KOA exhibited greater stride duration than controls (ES 1.35 [95% confidence interval (95% CI) 1.03, 1.67]) and a decrease in cadence (ES ؊0.75 [95% CI ؊1.12, ؊0.39]) compared with controls. The evidence for kinematic and joint moment change was primarily limited or conflicting. There was a lack of evidence for alterations in the external knee adduction moment. Conclusion. Individuals with KOA exhibit a range of gait deviations compared with controls. Despite its common usage in KOA gait studies, we did not find consistent evidence that knee adduction moment differs between those with and without KOA or between disease severity levels. Further research examining the reasons for a lack of difference in many gait variables in those with knee OA is needed.