Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity

Abstract

Mechanical factors have been implicated in the progression of knee osteoarthritis (OA). Understanding how these factors change as the condition progresses would elucidate their role and help in developing interventions that could delay the progress of knee OA. In this cross-sectional study, we identified kinematic and kinetic variables at the hip, knee, and ankle joints that change between three clinically distinct levels of knee OA disease severity: asymptomatic, moderate OA, and severe OA. The severity level was based on a combined radiographic/symptomatic clinical decision for treatment with (severe) or without (moderate) total knee replacement surgery. Gait variables that changed between groups were categorized as: those that differed between the asymptomatic group and both OA groups, those that differed between the asymptomatic group and the severe OA group only, or those that changed progressively, that is, the asymptomatic differed from the moderate OA, and the moderate OA differed from the severe OA group. Changes seen in both OA subject groups compared to asymptomatic included increased mid-stance knee adduction moments, decreased peak knee flexion moments, decreased peak hip adduction moments, and decreased peak hip extension moments. Changes found only in the severe knee OA group included multiple kinematic and kinetic differences at the hip, knee, and ankle joints. Gait differences that progressed with OA severity included decreased stance phase knee flexion angles, decreased early stance knee extension moments, decreased peak stance phase hip internal rotation moments, and decreased peak ankle dorsiflexion moments. ß

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

“…The 10°of lean reported may have possibly underestimated the true lean performed by participants as scapular depression or increased pelvic obliquity may alter the result. Finally, due to biomechanical differences between healthy and knee OA individuals (38), some variability between these study findings and Mundermann et al (10) may be explained. Nevertheless, increased trunk lean has consistently proven effective in reducing medial knee load.…”

Kinematic adaptations to a variable stiffness shoe: Mechanisms for reducing joint loading

“…One important marker and target for non-invasive intervention is the first peak of the external knee adduction moment in walking (Miyazaki et al, 2002). It is a surrogate marker of the relative load on the medial compartment (Schipplein and Andriacchi, 1991) and has been correlated with OA radiographic severity, rate of disease progression and severity of disease symptoms (Andriacchi et al, 2004;Andriacchi et al, 2009;Andriacchi and Mundermann, 2006;Astephen et al, 2007;Baliunas et al, 2002;Sharma et al, 1998).…”

Muscle Function during Selected Weight-Bearing Activities in Adults with Knee Osteoarthritis- A Narrative Overview

“…In addition to joint effusion criteria [45] , patients may need to be classified according to extent of postural sway, which is related to quadriceps activation and strength [47] , and by disease severity, age, and degree of muscle inflammation-if present, as one or more of these factors may alter knee kinematics and lower extremity neuromuscular function and load distribution during gait in some way [19,[63][64][65]67,68] . Very little work has examined patients with valgus deformities and lateral versus medial knee compartment osteoarthritis, and these angular deformities are not always accounted for in the present array of gait studies listed in Table 2.…”