Asymptomatic radiographic hip osteoarthritis is associated with gait differences,especially in women: A population-based study

BackgroundHip and knee osteoarthritis (OA) are debilitating diseases that impair gait at severe stages. Although associations between OA and gait are established for normal walking, little is known about its relation with turning and tandem (heel-to-toe) walking. Furthermore, it is unknown how asymptomatic OA associates with gait, and whether associations differ by sex. We investigated how symptomatic and asymptomatic hip and knee OA associate with gait in community-dwelling individuals.MethodsIn 2706 participants of a population-based cohort study, gait was assessed by electronic walkway and summarised into seven gait domains. Hip and knee radiographs were graded for radiographic OA (ROA) using the Kellgren and Lawrence (K&L) score. Linear regression was used to investigate associations between ROA and gait. Analyses were repeated including only participants with asymptomatic ROA, defined as a K&L-score of 2 without pain.ResultsIn total, 177 participants (6.5%) had hip ROA and 441 (16.3%) knee ROA. We found no associations of knee ROA with gait. Hip ROA associated with Rhythm, Tandem, and Turning. Furthermore, unilateral hip ROA associated with larger gait asymmetry and gait differences in osteoarthritic and non-osteoarthritic leg, when compared to people without hip ROA. Associations between hip ROA and gait were generally stronger for women than men. Associations for hip ROA remained after restricting to asymptomatic ROA.ConclusionHip ROA, but not knee ROA, associates with gait differences in normal walking, turning, and tandem walking in community-dwelling individuals. These associations differ between the sexes, and are already present for asymptomatic ROA.     

Immediate and 1 week effects of laterally wedge insoles on gait biomechanics in healthy females

It is estimated that approximately 45% of the U.S. population will develop knee osteoarthritis, a disease that creates significant economic burdens in both direct and indirect costs. Laterally wedged insoles have been frequently recommended to reduce knee abduction moments and to manage knee osteoarthritis. However, it remains unknown whether the lateral wedge will reduce knee abduction moments over a prolonged period of time. Thus, the purposes of this study were to (1) examine the immediate effects of a laterally wedged insole in individuals normally aligned knees and (2) determine prolonged effects after the insole was worn for 1 week. Gait analysis was performed on ten women with and without a laterally wedged insole. After participants wore the wedges for a week, a second gait analysis was performed with and without the insole. The wedged insole did not affect peak knee abduction moment, although there was a significant increase in knee abduction angular impulse after wearing the insoles for 1 week. Furthermore, there was a significant increase in vertical ground reaction force at the instance of peak knee abduction moment with the wedges. While the laterally wedged insole used in the current study did not alter knee abduction moments as expected, other studies have shown alterations. Future studies should also examine a longer acclimation period, the influence of gait speed, and the effect of different shoe types with the insole.     

Knee contact forces are not altered in early knee osteoarthritis

ObjectiveThis study calculated knee contact forces (KCF) and its relations with knee external knee adduction moments (KAM) and/or flexion moments (KFM) during the stance phase of gait in patients with early osteoarthritis (OA), classified based on early joint degeneration on Magnetic Resonance Imaging (MRI). We aimed at assessing if altered KCF are already present in early structural degeneration.DesignThree-dimensional motion and ground reaction force data in 59 subjects with medial compartment knee OA (N = 23 established OA, N = 16 early OA, N = 20 controls) were used as input for a musculoskeletal model. KAM and KFM, and KCF were estimated using OpenSim software.ResultsNo significant differences were found between controls and subjects with early OA. In early OA patients, KAM significantly explained 69% of the variance associated with the first peaks KCF but only KFM contributed to the second peaks KCF. The multiple correlation, combining KAM and KFM, showed to be higher. However, only 20% of the variance of second peak KCF was explained by both moments in established OA.ConclusionKCF are not increased in patients with early OA, suggesting that knee joint overload is more a consequence of further joint degeneration in more advanced stages of OA. Additionally, our results clearly show that KAM is not sufficient to predict joint loading at the end of the stance, where KFM contributes substantially to the loading, especially in early OA.     

Immediate effect of Masai Barefoot Technology shoes on knee joint moments in women with knee osteoarthritis

Footwear modification can beneficially alter knee loading in patients with knee osteoarthritis. This study evaluated the effect of Masai Barefoot Technology shoes on reductions in external knee moments in patients with knee osteoarthritis. Three-dimensional motion analysis was used to examine the effect of Masai Barefoot Technology versus control shoes on the knee adduction and flexion moments in 17 women (mean age, 63.6 years) with radiographically confirmed knee osteoarthritis. The lateral and anterior trunk lean values, knee flexion and adduction angles, and ground reaction force were also evaluated. The influence of the original walking pattern on the changes in knee moments with Masai Barefoot Technology shoes was evaluated. The knee flexion moment in early stance was significantly reduced while walking with the Masai Barefoot Technology shoes (0.25 ± 0.14 N m/kg m) as compared with walking with control shoes (0.30 ± 0.19 N m/kg m); whereas the knee adduction moment showed no changes. Masai Barefoot Technology shoes did not increase compensatory lateral and anterior trunk lean. The degree of knee flexion moment in the original walking pattern with control shoes was correlated directly with its reduction when wearing Masai Barefoot Technology shoes by multiple linear regression analysis (adjusted R² = 0.44, P < 0.01). Masai Barefoot Technology shoes reduced the knee flexion moment during walking without increasing the compensatory trunk lean and may therefore reduce external knee loading in women with knee osteoarthritis.     

Accelerometer-based determination of gait variability in older adults with knee osteoarthritis

Knee osteoarthritis (KOA) can affect the spatiotemporal (ST) aspects of gait as well as the variability of select ST parameters based on standard linear measures of variability (e.g., standard deviation (SD) and coefficient of variation). Non-linear measures (e.g., fractal scaling index (FSI) and sample entropy) can be more sensitive to changes in gait variability, and have been used to quantify differences in the stride patterns of patients with Parkinson’s disease and the motion of ACL-deficient knees. However, the effect of KOA on the dynamic complexity of the stride pattern has not been investigated. Therefore, the purpose of this study was to investigate the effect of KOA on gait variability (linear and non-linear measures) in a group of older adults, and to compare these results to a healthy control group. Participants walked for 10 min with a tri-axial accelerometer placed at the lower back. Mean and SDs of stride time and step time as well as the FSI for the entire series of stride times were calculated for each participant. Participants with KOA had significantly greater mean stride time (p = 0.031) and step time (p = 0.024) than control group participants. While stride and step time variability (SD) were greater in the KOA group, the differences were not significant, nor was the difference in the FSI. Low statistical power (β = 0.40 and 0.30 for stride and step time SD, respectively) combined with the confounding effects of walking speed and heterogeneous KOA severity likely prevented significant differences from being found.     

The relationship between muscle capacity utilization during gait and pain in people with symptomatic knee osteoarthritis

BackgroundMuscle capacity utilization reflects the percentage of maximal knee extensor strength required to complete physical activities.Research questionIs pain associated with muscle capacity utilization during walking in older adults with knee osteoarthritis? Secondarily, is muscle capacity utilization in older adults with knee osteoarthritis sex-specific?MethodsTwenty-three participants (15 females) with symptomatic knee OA completed this study [age 67 ( ± 8) years, body mass index 29.7 ( ± 3.9) kg/m², gait speed during the Six Minute Walk test 1.25 ( ± 0.25) m/s]. Pain was measured using the Knee injury and Osteoarthritis Outcome Score. Muscle capacity utilization was quantified as the peak external knee flexor moment during level walking normalized to knee extensor maximum voluntary isometric contraction. The knee flexor moment was calculated from kinematic and kinetic data during barefoot level walking at a self-selected speed and at 1.1 m/s. Knee extensor maximum voluntary isometric contraction was measured on a dynamometer. Multiple linear regressions were used to determine the relationship between pain and muscle capacity utilization after adjusting for age, sex, body mass index, and gait speed. Independent sample t-tests examined sex differences.ResultsPain was not associated with muscle capacity utilization during self-selected and standardized walking speeds (p = 0.38 and p = 0.36, respectively). Females did not require a greater muscle capacity utilization than males to complete gait at self-selected and standardized speeds (p = 0.28, and p = 0.40, respectively).SignificanceMuscle capacity utilization was not associated with pain during walking in people with knee osteoarthritis. Future work should explore more challenging activities of daily living in knee OA.     

Obstacle crossing in older adults with medial compartment knee osteoarthritis

This study investigated the biomechanical strategy adopted by older adults with medial compartment knee osteoarthritis for successful obstacle crossing. Fifteen older adults with bilateral medial compartment knee OA and 15 healthy controls were recruited to walk and cross obstacles of heights of 10%, 20% and 30% of their leg lengths. Kinematic and kinetic data were obtained using a three-dimensional (3D) motion analysis system and forceplates. The groups had comparable walking speeds, toe clearances and horizontal foot–obstacle distances (p > 0.05). When the swing toe was above the obstacle, the OA group showed smaller swing knee flexion (p = 0.01) and stance hip adduction (p = 0.003) and internal rotation (p = 0.04). They showed greater swing ankle dorsiflexion (p = 0.04) as well as swing-side pelvic listing (p = 0.006) and backward rotation (p = 0.02). They also exhibited greater peak knee abductor moments (p = 0.02) during early stance while adopting similar knee abductor moments (p = 0.04) and greater hip abductor moments (p = 0.04) when the leading toe was above the obstacle and thereafter. Smaller knee extensor (p < 0.004), yet greater hip extensor moments (p < 0.04), were found in the OA group throughout the stance phase. People with medial compartment knee OA had acquired different biomechanical strategies to compensate for the compromised function of the diseased knee.