Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression

Abstract

Objective. To test the hypothesis that a greater peak internal hip abduction moment is associated with a reduced likelihood of ipsilateral medial tibiofemoral osteoarthritis (OA) progression.Methods. Fifty-seven persons with knee OA (by definite osteophyte presence and symptoms) were evaluated. Baseline assessments included kinematic and kinetic gait parameters, obtained with an optoelectronic camera system and force platform, with inverse dynamics used to calculate 3-dimensional moments at the joints; pain, using a separate visual analog scale for each knee; and alignment, using full-limb radiographs. Radiographs of the knee in a semiflexed position, with fluoroscopic confirmation of tibial rim alignment, were obtained at baseline and 18 months later. Disease progression was defined as worsening of the grade of medial joint space narrowing. Logistic regression obtained with generalized estimating equations was used to estimate odds ratios (ORs) for progression per unit of hip abduction moment, after excluding knees with the worst joint space grade at baseline (which could not progress).Results. The 57 participants (63% women) with mild to moderate OA had a mean age of 67 years and a mean body mass index of 29. A greater internal hip abduction moment during gait was associated with a reduced likelihood of medial tibiofemoral OA progression, with OR/unit hip abduction moment of 0.52 and a 95% confidence interval (95% CI) of 0.32-0.85. This protective effect persisted after adjustment for age, sex, walking speed, knee pain severity, physical activity, varus malalignment severity, hip OA presence, and hip OA symptom presence, with an adjusted OR of 0.43 a 95% CI of 0.22-0.81. Conclusion.A greater hip abduction moment during gait at baseline protected against ipsilateral medial OA progression from baseline to 18 months. The likelihood of medial tibiofemoral OA progression was reduced 50% per 1 unit of hip abduction moment.

Individuals with severe knee osteoarthritis (OA) exhibit altered proximal walking mechanics compared with individuals with less severe OA and those without knee pain

“…Recent studies have reported differences in hip moments between those with and without knee OA (11) and between those who are and are not on a surgical waitlist (15), and support the earlier findings of Chang et al (12). In particular, those with greater disease severity exhibited lower external hip adduction moments and increased external hip abduction moments.…”

“…In particular, biomechanics at the hip, pelvis, and trunk have all been shown to affect dynamic joint loading at the knee (11)(12)(13)(14). The importance of these proximal joints is highlighted by findings from Chang et al (12), which showed that increased internal hip abduction moments (equivalent to external hip adduction moments) attributed to higher hip abduction strength were protective against OA progression in the knee over an 18-month period. Accord-ingly, the focus has shifted from solely examining changes at the knee during walking in those with knee OA to understanding factors that influence proximal gait mechanics.…”

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

“…In the MAK cohort, greater internal hip abduction moment during gait protected against medial tibiofemoral OA progression (14), suggesting that biomechanical factors at the knee and hip may interact. However, thigh rotation was not related to knee adduction during gait with toes out (20), implying a limited effect on the hip.…”

A Novel Experimental Knee-Pain Model Affects Perceived Pain and Movement Biomechanics

“…The ground reaction force (GRF) heavily influences knee-joint load. 15 Internal net hip-, knee-, and ankle-joint moments (ie, the net joint torques that are produced by internal structures such as muscles) also influence knee-joint load; eg, the net internal hip extension, 16 hip abduction, 17,18 knee extension, 19 plantar flexion, 19 and overall support moment 20 (the algebraic sum of the hipextension, knee-extension, and plantar-flexion moments) each contribute to vertical GRF and the corresponding tibiofemoral joint load. Peak external knee-adduction torque has also been associated with knee-joint load.…”