Association between in vivo knee kinematics during gait and the severity of knee osteoarthritis

doi:10.1016/j.knee.2011.11.002

The Knee

Volume 19, Issue 5, October 2012, Pages 628-632

https://doi.org/10.1016/j.knee.2011.11.002 Get rights and content

Abstract

Background

Osteoarthritis patients may exhibit different kinematics according to the disease stage. However, changes in the frontal and horizontal planes in each stage remain unclear. The purpose of this study was to investigate changes in the knee kinematic gait variables of osteoarthritis patients, including the frontal and horizontal planes, with respect to the severity of the disease.

Methods

Forty-five patients with knee osteoarthritis and 13 healthy young subjects were recruited for the experiment. All subjects were examined while walking on a 10-m walkway at a self-selected speed. In each trial, we calculated the angular displacements of flexion/extension, abduction/adduction, and external/internal tibial rotation. We also measured muscle strength, range of motion (ROM), and alignment. We compared the differences in osteoarthritis severity and knee kinematic variables between osteoarthritis patients and normal subjects.

Results

The flexion angle at the time of foot contact was significantly less in patients with severe and moderate osteoarthritis than in normal subjects (both p < 0.01). The abduction angle at the 50% stance phase was significantly less in patients with severe osteoarthritis than in normal subjects (p < 0.05). The excursion of axial tibial rotation was significantly less in patients with early osteoarthritis than in normal subjects (p < 0.05).

Conclusion

Osteoarthritis patients had different knee kinematics during gait, depending on the progress of osteoarthritis. Early-stage patients exhibit decreased axial tibial rotation excursion, while severe-stage patient exhibit increased knee adduction.

Introduction

Knee osteoarthritis (OA) is a degenerative disease that may be triggered by biomechanical or mechanical insults [1]. Gait analysis has been conducted to clarify the biomechanical characteristics of knee OA. Some studies [2], [3] examined patients with different or specific stages of knee OA as a single population and compared them with asymptomatic subjects as controls. However, degenerative changes in the joint develop according to the progress of OA. Furthermore, changes of muscle strength, range of motion (ROM), and alignment associated with disability is observed in OA patients. OA patients may exhibit different kinematics according to the OA stage. It is difficult to identify stage-specific biomechanical changes from a single population study.

Previous studies examined stage-specific kinematic changes in OA patients during gait [4], [5], [6]. These studies report that OA patients show decreased knee extension at initial contact [5], decreased peak knee flexion during the stance phase [4], and decreased knee excursion during flexion [6]. Peak knee flexion and excursion progress decrease with increasing OA severity [4], [6]. Although the kinematic changes in the sagittal plane of OA patients have been elucidated, changes in the frontal and horizontal planes remain unclear. Briem and Snyder-Mackler [7] report an increased knee adduction angle at initial contact and at the peak of knee adduction moments. However, they only examined moderate OA patients and compared side-to-side differences rather than comparing OA patients with control subjects. No study has examined the rotational changes of OA knees during gait.

Recent radiographic evidence suggests rotational changes occur in osteoarthritic knees [8], [9], [10]. Computed tomography images of osteoarthritic knees demonstrate excessive external tibial rotations, with greater magnitudes evident along with increased varus deformity [9]. Tibial external rotation biases from 20 to 100° have been observed in 3D kinematic model registration during squatting manoeuvres [8]. The screw-home mechanism is not observed in people with knee OA. During weight-bearing knee extension, Saari et al. [10] report decreased internal rotations using dynamic radio-stereometry. The results from these studies demonstrate altered transverse plane knee motion and warrant further investigation. However, as stated above, the rotation kinematics of the knee during gait have not been previously examined.

The purpose of this study was to investigate changes in the knee kinematic gait variables as well as the knee's physical function (i.e. muscle strength, ROM, and alignment) of knee OA patients in response to the severity of the disease (i.e. early, moderate, and severe). We hypothesised that knee OA patients exhibit the following different knee kinematics according to the progress of OA: decreased knee flexion, increased knee adduction, and external tibial rotation.

Section snippets

Subjects

Forty-five patients with knee OA and 13 healthy young subjects were recruited for the experiment. OA patients were recruited locally through public advertisements posted in the area surrounding the institute. Inclusion was based on clinical history and difficulty with at least one item on the American College of Rheumatology's Clinical and Radiographic Criteria for Classification and Reporting of Knee OA [11]. Patients were excluded if they had previous lower limb surgery, other orthopaedic

Results

According to the Kellgren–Lawrence criteria, 4, 10, 17, and 14 cases were classified as grade 1, 2, 3, and 4, respectively. The biological characteristics of the subjects who provided complete kinematic data are shown in Table 2.

Fig. 1 shows the mean time course comparisons across OA severities for the three angular displacements of the knee (i.e. flexion/extension, abduction/adduction, and external/internal tibial rotation). Means and standard deviations for all knee kinematic variables at the

Discussion

The purpose of this study was to investigate the changes in knee kinematic gait variables of knee OA patients in response to severity of the disease (i.e., early, moderate, and severe stages). Previous studies report the kinematic changes in knee OA patients [4], [5], [6]. However, almost all of these previous studies report sagittal plane knee kinematic changes; few studies mention frontal or horizontal knee kinematic changes during gait because the method for calculating knee kinematics is

Conclusion

We investigated the changes in the knee kinematic gait variables of knee OA patients in relation to the progression of the disease (i.e. early, moderate, and severe). Early stage patients showed decreased axial tibial rotation excursion, while their flexion/extension time course was almost identical to that of normal subjects. After the moderate stage, decreased knee flexion at the time of foot contact and at the 50% stance phase as well as decreased knee flexion excursion were observed.

Conflict of interest

No author of this manuscript has any conflicts of interest.

Acknowledgements

We thank Dr Hirofumi IDA for providing the PCT calculation programme. This research was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (B21300206) and a Health Labour Sciences Research Grant (H21-Disorder-General-105).

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Association between in vivo knee kinematics during gait and the severity of knee osteoarthritis

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Subjects

Results

Discussion

Conclusion

Conflict of interest

Acknowledgements

J Biomech

Clin Biomech (Bristol, Avon)

J Biomech

Orthop Clin North Am

Osteoarthritis: new insights. Part 1: the disease and its risk factors

Ann Intern Med

Osteoarthritis of the knee: effects on gait, strength, and flexibility

Arch Phys Med Rehabil

Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity

J Orthop Res

Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking

Arthritis Rheum

Proximal gait adaptations in medial knee OA

J Orthop Res

Knee kinematics in medial osteoarthritis during in vivo weight-bearing activities

J Orthop Res