Relationships among bone mineral densities, static alignment and dynamic load in patients with medial compartment knee osteoarthritis

Wada, Makoto; Maezawa, Yasuhisa; Baba, H.; Shimada, Seiichiro; Sasaki, Shinichi; Nose, Yorito

doi:10.1093/rheumatology/40.5.499

Cited by 175 publications

(150 citation statements)

References 37 publications

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“…This finding is consistent with some DXA studies (14), but not others, in which both increased and decreased aBMD have been reported in those with knee OA (15)(16)(17). However, it is difficult to make direct comparisons given the differences between DXA and pQCT.…”

Section: Discussionsupporting

confidence: 90%

“…Overall, the medial knee joint compartment experiences greater load than the lateral compartment (27). This load differential is exacerbated by more severe disease (28) and joint malalignment (17,29). However, within the medial compartment, the actual distribution of loading and cartilage wear patterns across the tibial plateau are complex, heterogeneous, and not consistently established.…”

Section: Discussionmentioning

confidence: 99%

“…It has been surmised that lower bone density beneath the lateral compartment may simply represent disuse osteopenia (4,47). This could be due to the fact that more of the load is shifted to the medial compartment due to increasing varus malalignment and joint changes as the disease progresses (17,28,29). It is also possible that reduced physical activity levels as a person's disease severity worsens (48) could lower the overall amount of loading taken through the knee.…”

Section: Discussionmentioning

confidence: 99%

“…Fractal signature analysis of macroradiographs has shown thinning of vertical trabeculae, in particular, to be characteristic of the predominantly less dense subchondral trabecular bone in OA (5,12,13). The few DXA studies, however, are contradictory, with reports of no difference (5,14), and lower (15) or higher (16,17) apparent aBMD in the OA groups compared with controls.…”

mentioning

confidence: 99%

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Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Bennell¹,

Creaby²,

Wrigley³

et al. 2008

Arthritis & Rheumatism

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Objective. Knee osteoarthritis (OA) is an organlevel failure of the joint involving pathologic changes in articular cartilage and bone. This cross-sectional study compared apparent volumetric bone mineral density (vBMD) of proximal tibial subchondral trabecular bone in people with and without knee OA, using peripheral quantitative computed tomography (pQCT).Methods. Seventy-five individuals with mild or moderate medial compartment knee OA and 41 asymptomatic controls were recruited. Peripheral QCT was used to measure vBMD of trabecular bone beneath medial and lateral tibiofemoral compartments at levels of 2% and 4% of tibial length, distal to the tibial plateau.Results. There was no significant difference in vBMD beneath the overall medial and lateral compartments between the 3 groups. However, in the affected medial compartment of those with moderate OA, lower vBMD was seen in the 2 posterior subregions compared with controls and those with mild knee OA, while higher vBMD was seen in the anteromedial subregion. Beneath the unaffected or lesser affected lateral compartment, significantly lower vBMD was seen at the 2% level in the anterior and lateral subregions of those with moderate disease. Volumetric BMD ratios showed relatively higher vBMD in the medial compartment compared with the lateral compartment, but these ratios were not influenced by disease status.Conclusion. Subregional vBMD changes were evident beneath the medial and lateral compartments of those with moderate medial knee OA. Of import, the posterior subchondral trabecular regions of the medial tibial plateau have markedly lower vBMD.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Bennell¹,

Creaby²,

Wrigley³

et al. 2008

Arthritis & Rheumatism

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“…Although some previous studies have found similar strengths of correlation as found in the present study between dynamic loading parameters and BMD or BMC [5,11,36], these studies have focused on populations with gait abnormalities due to knee and hip osteoarthritis or total hip arthroplasty. The present study focused on normal subjects with no known musculoskeletal problems.…”

Section: Discussionsupporting

confidence: 57%

Dynamic loads are determinants of peak bone mass

Moisio

Hurwitz

Sumner

2004

Journal Orthopaedic Research

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This study investigated the association between non‐invasive measurements of bone mass and markers of dynamic and static hip joint loads in subjects expected to be at peak bone mass. The bone mineral density (BMD) and bone mineral content (BMC) of three proximal femoral sites (neck, greater trochanter, and total) were measured by dual energy X‐ray absorptiometry, and the peak external joint moments at the hip during walking and jogging were calculated from gait analyses of 31 normal human subjects ranging in age from 30 to 49 years (18 females, 13 males). Various multiple regression analyses were performed to determine how much of the variance in BMD and BMC was explained by height, body mass, and the peak hip joint moments. In total, the models explained up to 40% of the variance in BMD and 58% of the variance in BMC. Inclusion of height or body mass did not increase the explanatory power of the models for BMD and explained no more than 8% of the total variance in BMC once the joint moments from walking were allowed to enter the models. These data support the hypothesis that variance in peak bone mass is associated with variance in dynamic hip loads largely independent of the effect of static factors such as height and body mass. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.

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Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

Henriksen¹,

Graven‐Nielsen²,

Aaboe³

et al. 2010

Arthritis Care & Research

149

112

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Objective. Medial knee osteoarthritis (OA) is characterized by pain and associated with abnormal knee moments during walking. The relationship between knee OA pain and gait changes remains to be clarified, and a better understanding of this link could advance the treatment and prevention of disease progression. This study investigated changes in knee moments during walking following experimental knee pain in healthy volunteers, and whether these changes replicated the joint moments observed in medial knee OA patients. Methods. In a crossover study, 34 healthy subjects were tested on 3 different days; gait analyses were conducted before, during, and after pain induced by hypertonic saline injections (0.75 ml) into the infrapatellar fat pad. Isotonic saline and sham injections were used as control conditions. Peak moments in frontal and sagittal planes were analyzed. The results were compared with data from 161 medial knee OA patients. The patients were divided into less severe OA and severe OA categories, which was based on radiographic disease severity of the medial compartment. Results. Experimental knee pain led to reduced peak moments in the frontal and sagittal planes in the healthy subjects, which were similar to the patterns observed in less severe OA patients while walking at the same speed. Conclusion. In healthy subjects, pain was associated with reductions in knee joint moments during walking in a manner similar to less severe knee OA patients. The experimental model may be used to study mechanically-driven knee OA progression and preventive measures against abnormal joint loading in knee OA.

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Relationships among bone mineral densities, static alignment and dynamic load in patients with medial compartment knee osteoarthritis

Abstract: Our results suggest that the bone mineral distribution of the proximal tibia is directly affected but lumbar BMD is not influenced by the local mechanical stress around the knee with medial compartment OA.

Cited by 175 publications

References 37 publications

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Dynamic loads are determinants of peak bone mass

Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

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