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1.
After unilateral total hip replacement (THR) for hip osteoarthritis (OA), knee OA incidence or progression is common. The contralateral knee is at particular risk, and some have speculated that abnormal THR‐hip biomechanics contributes to this asymmetry. We investigated the relationships between operated‐hip joint geometry or gait variables and the peak external knee adduction moments—an indicator of knee OA risk—in 21 subjects with unilateral THRs. We found that the peak adduction moment was 14% higher on the contralateral versus the ipsilateral knee (p = 0.131). The best predictors of ipsilateral knee adduction moments were superior‐inferior joint center position and operated‐hip peak adduction moment (adj R2 = 0.291, p = 0.017). The sole predictor of the contralateral knee adduction moment was the medial‐lateral hip center position (adj R2 = 0.266, p = 0.010). A postoperative medial shift of the hip center was significantly correlated with a lower postoperative contralateral/ipsilateral knee adduction moment ratio (R = 0.462, p = 0.035). Based on these relationships, we concluded that implant positioning could influence the biomechanical risk of knee OA progression after THR. Although implant positioning decisions are necessarily driven by other factors, it may be appropriate to assess individual THR candidate's knee OA risk and adjust perioperative management accordingly. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1187–1194, 2013 相似文献
2.
The purpose of this study was to examine interlimb differences in gait kinematics and kinetics in patients with symptomatic medial knee OA. The main objective was to identify hip joint movement strategies that might lower the knee adduction moment and also compensate for decreased knee flexion during weight acceptance. Gait analysis was performed on 32 patients with moderate medial compartment knee OA. Kinetic and kinematic data were calculated and side‐to‐side comparisons made. Radiographs were used to identify frontal plane alignment. No interlimb difference in the peak knee adduction moment was found (p = 0.512), whereas a greatly reduced hip adduction moment was seen on the involved side (p < 0.001) during the early part of stance. The involved limb flexed significantly less and hip and knee flexion moments were smaller compared to the uninvolved side. Gait adaptations involving a lateral sway of the trunk may successfully lead to relatively lower ipsilateral knee adduction moments, and would further be reflected by a lower adduction moment at the hip. Subjects did not compensate for less knee flexion by any dynamic means, and likely experience a resulting higher joint impact. These gait adaptations may have implications with respect to development of weakness of the ipsilateral hip musculature and progression of multiarticular OA. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:78–83, 2009 相似文献
3.
Increased knee joint loads during walking are present in subjects with knee osteoarthritis 总被引:3,自引:0,他引:3
Baliunas AJ Hurwitz DE Ryals AB Karrar A Case JP Block JA Andriacchi TP 《Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society》2002,10(7):573-579
OBJECTIVE: This study tests the hypothesis that the peak external knee adduction moment during gait is increased in a group of ambulatory subjects with knee osteoarthritis (OA) of varying radiographic severity who are being managed with medical therapy. Tibiofemoral knee OA more commonly affects the medial compartment. The external knee adduction moment can be used to assess the load distribution between the medial and lateral compartments of the knee joint. Additionally, this study tests if changes in the knee angles, such as a reduced midstance knee flexion angle, or reduced sagittal plane moments previously identified by others as load reducing mechanisms are present in this OA group. DESIGN: Thirty-one subjects with radiographic evidence of knee OA and medial compartment cartilage damage were gait tested after a 2-week drug washout period. Thirty-one normal subjects (asymptomatic control subjects) with a comparable age, weight and height distribution were also tested. Significant differences in the sagittal plane knee motion and peak external moments between the normal and knee OA groups were identified using t tests. RESULTS: Subjects with knee OA walked with a greater than normal peak external knee adduction moment (P=0.003). The midstance knee flexion angle was not significantly different between the two groups (P=0.625) nor were the peak flexion and extension moments (P> 0.037). CONCLUSIONS: Load reducing mechanisms, such as a decreased midstance knee flexion angle, identified by others in subjects with endstage knee OA or reduced external flexion or extension moments were not present in this group of subjects with knee OA who were being managed by conservative treatment. The finding of a significantly greater than normal external knee adduction moment in the knee OA group lends support to the hypothesis that an increased knee adduction moment during gait is associated with knee OA. 相似文献
4.
Katerina Blazek Julien Favre Jessica Asay Jennifer Erhart‐Hledik Thomas Andriacchi 《Journal of orthopaedic research》2014,32(3):394-402
Articular cartilage is sensitive to mechanical loading, so increased risk of osteoarthritis in older or obese individuals may be linked to changes in the relationship between cartilage properties and extrinsic joint loads. A positive relationship has been reported between ambulatory loads and cartilage thickness in young individuals, but whether this relationship exists in individuals who are older or obese is unknown. This study examined the relationship between femoral cartilage thickness and load, measured by weight × height and the peak adduction moment, in young normal‐weight (28 subjects, age: 28.0 ± 3.8 years, BMI: 21.9 ± 1.9 kg/m2), middle‐aged normal‐weight (27 subjects, 47.0 ± 6.5 years, 22.7 ± 1.7 kg/m2), young overweight/obese (27 subjects, 28.4 ± 3.6 years, 33.3 ± 4.6 kg/m2), and middle‐aged overweight/obese (27 subjects, 45.8 ± 7.2 years, 31.9 ± 4.4 kg/m2) individuals. On the lateral condyle, cartilage thickness was positively correlated with weight × height for all groups (R2 = 0.26–0.20) except the middle‐aged overweight/obese. On the medial condyle, weight × height was significantly correlated only in young normal‐weight subjects (R2 = 0.19), as was the case for the correlation between adduction moment and medial–lateral thickness ratio (R2 = 0.20). These results suggest that aging and obesity are both associated with a loss of the positive relationship between cartilage thickness and ambulatory loads, and that the relationship is dependent on the compartment and whether the load is generated by body size or subject‐specific gait mechanics. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:394–402, 2014. 相似文献
5.
Jennifer C. Erhart Chris O. Dyrby Darryl D. D'Lima Clifford W. Colwell Thomas P. Andriacchi 《Journal of orthopaedic research》2010,28(12):1548-1553
External knee adduction moment can be reduced using footwear interventions, but the exact changes in in vivo medial joint loading remain unknown. An instrumented knee replacement was used to assess changes in in vivo medial joint loading in a single patient walking with a variable‐stiffness intervention shoe. We hypothesized that during walking with a load modifying variable‐stiffness shoe intervention: (1) the first peak knee adduction moment will be reduced compared to a subject's personal shoes; (2) the first peak in vivo medial contact force will be reduced compared to personal shoes; and (3) the reduction in knee adduction moment will be correlated with the reduction in medial contact force. The instrumentation included a motion capture system, force plate, and the instrumented knee prosthesis. The intervention shoe reduced the first peak knee adduction moment (13.3%, p = 0.011) and medial compartment joint contact force (12.3%; p = 0.008) compared to the personal shoe. The change in first peak knee adduction moment was significantly correlated with the change in first peak medial contact force (R2 = 0.67, p = 0.007). Thus, for a single subject with a total knee prosthesis the variable‐stiffness shoe reduces loading on the affected compartment of the joint. The reductions in the external knee adduction moment are indicative of reductions in in vivo medial compressive force with this intervention. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1548–1553, 2010 相似文献
6.
《Journal of orthopaedic research》2017,35(2):321-330
7.
The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial
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Richard K. Jones Graham J. Chapman Matthew J. Parkes Laura. Forsythe David T. Felson 《Journal of orthopaedic research》2015,33(11):1646-1654
Many conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA. Seventy individuals with medial knee OA underwent three‐dimensional walking gait analysis in five conditions (barefoot, control shoe, typical wedge, supported wedge, and mobility shoe) with pain and comfort recorded concurrently. The change in EKAM, KAAI, external knee flexion moment, pain, and comfort were assessed using multiple linear regressions and pairwise comparisons. Compared with the control shoe, lateral wedge insoles and barefoot walking significantly reduced early stance EKAM and KAAI. The mobility shoe showed no effect. A significant reduction in latter stance EKAM was seen in the lateral wedge insoles compared to the other conditions, with only the barefoot condition reducing the external knee flexion moment. However, the mobility shoe showed significant immediate knee pain reduction and improved comfort scores. Different lateral wedge insoles show comparable reductions in medial knee loading and in our study, the mobility shoe did not affect medial loading. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 33:1646–1654, 2015. 相似文献
8.
《Journal of orthopaedic research》2017,35(10):2251-2259
9.
Abnormal loading of the hip and knee joints in unilateral hip osteoarthritis persists two years after total hip replacement
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Felix Stief André Schmidt Stefan van Drongelen Katharina Lenarz Dara Froemel Timur Tarhan Frederick Lutz Andrea Meurer 《Journal of orthopaedic research》2018,36(8):2167-2177
10.
Derek N. Pamukoff Michael N. Vakula Skylar C. Holmes Eric J. Shumski Steven A. Garcia 《Journal of orthopaedic research》2020,38(12):2685-2695
This study compared femoral cartilage characteristics between age- and sex-matched individuals with (n = 48, age = 22.8 ± 3.5 years; body mass index [BMI] = 33.1 ± 4.1 kg/m2) and without obesity (n = 48 age = 22.0 ± 2.6 years; BMI = 21.7 ± 1.7 kg/m2) and evaluated the associations between body composition, quadriceps function, and gait kinetics with femoral cartilage characteristics. Medial and lateral femoral cartilage thickness, medial:lateral thickness ratio and medial and lateral cartilage echo intensity were measured using ultrasound imaging. Body composition was assessed using air displacement plethysmography. Quadriceps function was assessed via maximal isometric knee extension. Three-dimensional gait biomechanics were recorded to extract peak external knee flexion and adduction moments, and peak loading rate of the vertical ground reaction force. Cartilage outcomes were compared between groups using one-way multivariate analysis of variance. Stepwise moderated regression evaluated the association between body composition, quadriceps function, and gait kinetics with femoral cartilage outcomes in individuals with and without obesity. Medial (75.24 vs 65.84; P < .001, d = 1.02) and lateral (58.81 vs 52.22; P < .001, d = 0.78) femoral cartilage echo intensity were higher in individuals with compared with those without obesity. A higher body fat percentage was associated with higher medial and lateral cartilage echo intensity (ΔR2 = 0.09-0.12) in individuals with obesity. A higher knee adduction moment was associated with a larger medial:lateral thickness ratio (ΔR2 = 0.09) in individuals without obesity. No associations were found between quadriceps function and cartilage outcomes. These findings suggest that high body fat in adults with obesity is associated with cartilage echo intensity. The obese body mass index was also associated with a lack of a positive relationship between cartilage thickness and joint loading during walking. 相似文献
11.
Mariska Wesseling Friedl de Groote Christophe Meyer Kristoff Corten Jean‐Pierre Simon Kaat Desloovere Ilse Jonkers 《Journal of orthopaedic research》2015,33(7):1094-1102
Patients with hip pathology present alterations in gait which have an effect on joint moments and loading. In knee osteoarthritic patients, the relation between medial knee contact forces and the knee adduction moment are currently being exploited to define gait retraining strategies to effectively reduce pain and disease progression. However, the relation between hip contact forces and joint moments has not been clearly established. Therefore, this study aims to investigate the effect of changes in hip and pelvis kinematics during gait on internal hip moments and contact forces which is calculated using muscle driven simulations. The results showed that frontal plane kinetics have the largest effect on hip contact forces. Given the high correlation between the change in hip adduction moment and contact force at initial stance (R2 = 0.87), this parameter can be used to alter kinematics and predict changes in contact force. At terminal stance the hip adduction and flexion moment can be used to predict changes in contact force (R2 = 0.76). Therefore, gait training that focuses on decreasing hip adduction moments, a wide base gait pattern, has the largest potential to reduce hip contact forces. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1094–1102, 2015. 相似文献
12.
Erhart-Hledik JC Elspas B Giori NJ Andriacchi TP 《Journal of orthopaedic research》2012,30(4):514-521
This study investigated the load‐modifying and clinical efficacy of variable‐stiffness shoes after 12 months in subjects with medial compartment knee osteoarthritis. Subjects who completed a prior 6‐month study were asked to wear their assigned constant‐stiffness control or variable‐stiffness intervention shoes during the remainder of the study. Changes in peak knee adduction moment, total Western Ontario and McMaster Universities (WOMAC), and WOMAC pain scores were assessed. Seventy‐nine subjects were enrolled, and 55 completed the trial. Using an intention‐to‐treat analysis, the variable‐stiffness shoes reduced the within‐day peak knee adduction moment (?5.5%, p < 0.001) in the intervention subjects, while the constant‐stiffness shoes increased the peak knee adduction moment in the control subjects (+3.1%, p = 0.015) at the 12‐month visit. WOMAC pain and total scores for the intervention group were significantly reduced from baseline to 12 months (?32%, p = 0.002 and ?35%, p = 0.007, respectively). The control group had a reduction of 27% in WOMAC pain score (p = 0.04) and no significant reduction in total WOMAC score. Reductions in WOMAC pain and total scores were similar between groups (p = 0.8 and p = 0.47, respectively). In the intervention group, reductions in adduction moment were related to improvements in pain and function (R2 = 0.11, p = 0.04). Analysis by disease severity revealed greater efficacy in adduction moment reduction in the less severe intervention group. While the long‐term effects of the intervention shoes on pain and function did not differ from control, the data suggest wearing the intervention shoe reduces the within‐day adduction moment after long‐term wear, and thus should reduce loading on the affected medial compartment of the knee. © 2011 Orthopaedic Research Society. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:514–521, 2012 相似文献
13.
Based on the premise that bone mass and bone geometry are related to load history and that subchondral bone may play a role in osteoarthritis (OA), we sought to determine if static and dynamic markers of knee joint loads explain variance in the medial-to-lateral ratio of proximal tibial bone mineral density (BMD) in subjects with mild and moderate medial knee OA. We utilized two surrogate markers of dynamic load, the peak knee adduction moment and the knee adduction angular momentum, the latter being the time integral of the frontal plane knee joint moment. BMD for medial and lateral regions of the proximal tibial plateau and one distal region in the tibial shaft was measured in 84 symptomatic subjects with Kellgren and Lawrence radiographic OA grades of 2 or 3. Utilizing gait analysis, the peak knee adduction moment (the external adduction moment of greatest magnitude) and the time integral of the frontal plane knee joint moment (the angular momentum) over the entire stance phase as well as for each of the four subdivisions of stance were calculated. The BMD ratio was not significantly different in grade 2 (1.32 +/- 0.27) and grade 3 knees (1.47 +/- 0.40) (P = 0.215). BMD of the tibial shaft was not correlated with any loading parameter or static alignment. Of all the surrogate gait markers of dynamic load, the knee adduction angular momentum in terminal stance explained the most variance (20%) in the medial-to-lateral BMD ratio (adjusted r(2) = 0.196, P < 0.001). The knee adduction angular momentum for the entire stance phase explained 18% of the variance in the BMD ratio (adjusted r(2) = 0.178, P < 0.001), 10% more variance than explained by the overall peak knee adduction moment (adjusted r(2) = 0.081, P < 0.001). 18% of the variance in the BMD ratio was also explained by the knee alignment angle (adjusted r(2) = 0.183, P < 0.001), and the total explanatory power was increased to 22% when the knee adduction angular momentum in terminal stance was added (change in r(2) = 0.041, P < 0.05, total adjusted r(2) = 0.215, P < 0.001). The BMD ratio and its relationship to dynamic and static markers of loading were independent of height, weight, and the body mass index, demonstrating that both dynamic markers of knee loading as well as knee alignment explained variance in the tibial BMD ratio independent of body size. 相似文献
14.
JenniferC Erhart‐Hledik ConstanceR Chu JessicaL Asay Julien Favre ThomasP Andriacchi 《Journal of orthopaedic research》2019,37(7):1546-1554
This study investigated associations between changes in the total joint moment (TJM) at the knee and changes in cartilage thickness after anterior cruciate ligament reconstruction (ACLR). Seventeen subjects (five males; age: 29.6 ± 7.3 years) with unilateral ACLR underwent gait analysis and magnetic resonance imaging at baseline (2.2 ± 0.3 years post‐ACLR) and at long‐term follow‐up (7.7 ± 0.7 years post‐ACLR). Knee loading was assessed using the TJM, and differences in loading were analyzed using repeated measures analysis of variance. Pearson correlation coefficients assessed associations between changes in TJM and changes in (medial‐to‐lateral) M/L femoral cartilage thickness ratios in the ACLR limb. Bilaterally, there was no significant change in the magnitude of the TJM first peak (TJM1), however, there was a significant increase in the percent contribution of the knee flexion moment (KFM) (p < 0.001) and decrease in the percent contribution of the knee adduction moment (KAM) to TJM1 (p < 0.001). The change in the percent contributions of KFM and KAM to TJM1 were associated with changes in M/L femoral cartilage thickness in the ACLR limb. Specifically, subjects with smaller increases in KFM contribution (R = 0.521, p = 0.032) and smaller decreases in KAM contribution (R = ?0.521, p = 0.032) had a reduction in the M/L ratio in the central femoral subregion over the follow‐up period, with similar trends in the external femoral subregion. The study results provide new insight into changes in the loading environment at the knee joint prospectively following ACL reconstruction and give evidence that there are modifiable gait metrics that are associated with cartilage changes after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1546–1554, 2019. 相似文献
15.
Changes in the total knee joint moment in patients with medial compartment knee osteoarthritis over 5 years
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Jessica L. Asay Jennifer C. Erhart‐Hledik Thomas P. Andriacchi 《Journal of orthopaedic research》2018,36(9):2373-2379
16.
《Journal of orthopaedic research》2017,35(6):1283-1289
17.
Elizabeth M. Russell Ross H. Miller Brian R. Umberger Joseph Hamill 《Journal of orthopaedic research》2013,31(5):665-671
Obesity is the primary risk factor for knee osteoarthritis (OA). Greater external knee adduction moments, surrogate measures for medial compartment loading, are present in Obese individuals and may predispose them to knee OA. Laterally wedged insoles decrease the magnitude of the external adduction moment in Obese individuals but it is unknown how they alter the center of pressure on the tibial plateau. A gait analysis was performed on 14 Obese (avg. 29.3 years; BMI range: 30.3–51.6 kg/m2) and 14 lean women (avg. 26.1 years; BMI range: 20.9–24.6 kg/m2) with and without a full‐length, wedged insole. Computed joint angles, joint moments, and knee extensor strength values were input into a musculoskeletal model to estimate center of pressure of the contact force on the tibial plateau. Statistical significance was assessed using a two‐way ANOVA to compare the main effects of group and insole condition (α = 0.05). The insole resulted in a significant (p < 0.01) lateral shift in the center of pressure location in both the Obese and Control groups (mean: 2.9 ± 0.7 and 1.5 ± 0.7 mm, respectively). The insole also significantly reduced the peak external knee adduction moment 1.88 ± 1.82 N m in the Control group (p < 0.01) and 3.62 ± 3.90 N m in the Obese group (p < 0.01). The results of this study indicate the effects of a prophylactic wedged insole for reducing the magnitude of the load on the knee's medial compartment in Obese women who are at risk for knee OA development. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 665–671, 2013 相似文献
18.
Jonathan P. Walter Darryl D. D'Lima Clifford W. Colwell Jr Benjamin J. Fregly 《Journal of orthopaedic research》2010,28(10):1348-1354
Excessive contact force is believed to contribute to the development of medial compartment knee osteoarthritis. The external knee adduction moment (KAM) has been identified as a surrogate measure for medial contact force during gait, with an abnormally large peak value being linked to increased pain and rate of disease progression. This study used in vivo gait data collected from a subject with a force‐measuring knee implant to assess whether KAM decreases accurately predict corresponding decreases in medial contact force. Changes in both quantities generated via gait modification were analyzed statistically relative to the subject's normal gait. The two gait modifications were a “medial thrust” gait involving knee medialization during stance phase and a “walking pole” gait involving use of bilateral walking poles. Reductions in the first (largest) peak of the KAM (32–33%) did not correspond to reductions in the first peak of the medial contact force. In contrast, reductions in the second peak and angular impulse of the KAM (15–47%) corresponded to reductions in the second peak and impulse of the medial contact force (12–42%). Calculated reductions in both KAM peaks were highly sensitive to rotation of the shank reference frame about the superior–inferior axis of the shank. Both peaks of medial contact force were best predicted by a combination of peak values of the external KAM and peak absolute values of the external knee flexion moment (R2 = 0.93). Future studies that evaluate the effectiveness of gait modifications for offloading the medial compartment of the knee should consider the combined effect of these two knee moments. Published by Wiley Periodicals, Inc. J Orthop Res 28:1348–1354, 2010 相似文献
19.
《The Journal of arthroplasty》1996,11(5):553-559
Gait analysis was used to study patients who underwent cemented medial unicompartmental knee arthroplasty (UKA) for medial compartment degenerative knee disease. All had excellent clinical function of the operated knee, with minimal involvement of other joints. Ten patients met the inclusion criteria for this study. Gait findings from this study group, as well as those from a similar cohort of patients who had undergone total knee arthroplasty (TKA), were compared with those for a group of normal patients. A greater percentage of patients (7 of 10) following UKA maintained the normal biphasic flexion/extension moment pattern about the knee or demonstrated a quadriceps overuse pattern, when compared with similar groups following TKA. In addition, the adduction moment in patients following UKA was significantly larger than in patients following TKA. The postoperative limb alignment correlated with the peak adduction moment recorded during the patient's gait analysis. The postoperative alignment may explain the differences in the adduction moment between the UKA and TKA patients, as there tended to be residual varus in the UKA population. The results of this study imply that preservation of the anterior cruciate ligament during UKA allows patients to maintain normal quadriceps mechanics, and that residual varus alignment subjects a medial UKA to higher loads. 相似文献
20.
Muscle stabilization strategies in people with medial knee osteoarthritis: The effect of instability
The sensation of knee instability (shifting, buckling. and giving way) is common in people with medial knee osteoarthritis (OA). Its influence on knee stabilization strategies is unknown. This study investigated the influence of knee instability on muscle activation during walking when knee stability was challenged. Twenty people with medial knee OA participated and were grouped as OA Stable (OAS) (n = 10) and OA Unstable (OAU) (n = 10) based on self‐reported knee instability during daily activities. Quadriceps strength, passive knee laxity, and varus alignment were assessed and related to knee instability and muscle cocontraction during walking when the support surface translated laterally. Few differences in knee joint kinematics between the groups were seen; however, there were pronounced differences in muscle activation. The OAU group used greater medial muscle cocontraction before, during, and following the lateral translation. Self‐reported knee instability predicted medial muscle cocontraction, but medial laxity and limb alignment did not. The higher muscle cocontraction used by the OAU subjects appears to be an ineffective strategy to stabilize the knee. Instability and high cocontraction can be detrimental to joint integrity, and should be the focus of future research. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1180–1185, 2008 相似文献