Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: Reduced walking speed

Abstract

Objective. To determine whether reducing walking speed is a strategy used by patients with knee osteoarthritis (OA) of varying disease severity to reduce the maximum knee adduction moment.Methods. Self-selected walking speeds and maximum knee adduction moments of 44 patients with medial tibiofemoral OA of varying disease severity, as assessed by using the Kellgren/Lawrence grade, were compared with those of 44 asymptomatic control subjects matched for sex, age, height, and weight.Results. Differences in self-selected normal walking speed explained only 8.9% of the variation in maximum knee adduction moment for the group of patients with knee OA. The severity of the disease influenced the adduction moment-walking speed relationship; the individual slopes of this relationship were significantly greater in patients with less severe OA than in asymptomatic matched control subjects. Self-selected walking speed did not differ between patients with knee OA, regardless of the severity, and asymptomatic control subjects. However, knees with more-severe OA had significantly greater adduction moments (mean ؎ SD 3.80 ؎ 0.89% body weight ؋ height) and were in more varus alignment (6.0 ؎ 4.5°) than knees with less-severe OA (2.94 ؎ 0.70% body weight ؋ height; and 0.0 ؎ 2.9°, respectively).Conclusion. Patients with less-severe OA adapt a walking style that differs from that of patients with more-severe OA and controls. This walking style is associated with the potential to reduce the adduction moment when walking at slower speeds and could be linked to decreased disease severity.Mechanical loads placed upon the joint during walking have been related to the progression of knee osteoarthritis (OA) (1,2). Theoretical estimations show that loads transferred through the medial compartment of the knee are ϳ2.5 times greater than loads transferred through the lateral compartment of the knee (3), and the majority of symptomatic OA knees are radiographically diagnosed with degenerative changes in the medial compartment of the joint (4). Moreover, increased mechanical load on the medial compartment of the knee has been associated with knee varus alignment, typically measured statically as mechanical axis alignment (5) or dynamically as external knee adduction moment (3), and a positive correlation between mechanical axis alignment and maximum external knee adduction moment has been reported (6,7).The relevance of the maximum knee adduction moment for the course of the disease has been emphasized by results of recent studies (1,2) that showed that high maximum adduction moments at the knee at a controlled walking speed are related to OA disease severity and to a higher rate of progression of knee OA. Nevertheless, it is still unclear whether the maximum knee adduction moment in patients with OA is higher than that of healthy control subjects when walking at

Gait Mechanics Influence Healthy Cartilage Morphology and Osteoarthritis of the Knee

“…2-B). The relationship between the high adduction moments and thinner cartilage in patients with osteoarthritis of the knee is consistent with the findings of clinical studies, which suggest that the adduction moment during walking can be predictive of the clinical outcome of treatment 11 , disease severity 12,13 , and disease progression 14 for medialcompartment osteoarthritis of the knee. The contrasting results for the healthy knee and the osteoarthritic knee suggest that healthy cartilage responds positively to load, whereas degraded cartilage in osteoarthritic knees responds negatively to load.…”

Gait modification strategies for altering medial knee joint load: A systematic review

“…Seven studies (29 -35) evaluated the effect of increasing toe-out, 3 of which also evaluated reducing toe-out (31)(32)(33). Alteration of gait speed was also investigated, with 7 studies evaluating increasing speed (36 -42) and 4 studies investigating reduced speed (36,39,40,42). Gait aids were investigated in 3 studies, 2 of which evaluated contralateral cane use (43,44), 1 investigated ipsilateral cane use (43), and 1 examined Nordic walking poles (45).…”

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

“…Several studies have reported the knee adduction moment during walking is associated with the presence [2,42] and rate of progression [36] of medial compartment knee osteoarthritis (OA) and has been used to predict the outcome of treatment interventions for OA [45]. Clinical and analytic studies [1,46] associate external adduction moment with excessive loading of the medial compartment.…”