Obesity and Its Influence on Knee Joint Contact Forces in Individuals With Moderate Knee Osteoarthritis

Obesity is known as a major risk factor for the development and progression of knee OA. It has been proposed to affect the joint through linked mechanical and metabolic factors. However, its precise role in the pathomechanics of the disease is still not well understood. Given the importance of altered mechanical environment in both initiation and progression of knee OA, it is crucial to examine if and how obesity may affect the joint mechanically.

This thesis is a continuing work of our group on the role obesity and its influence on joint mechanics. Previous work in our group showed that obese individuals walk with altered pattern of knee joint loading and furthermore, obesity may expose the joint to higher absolute contact forces, found through an inverse dynamics model. Following the previous work by our group, in this thesis we used the method of principal component analysis to examine the role of obesity and its interaction with moderate knee OA on the neuromuscular patterns of major knee muscles. Our results showed that obese individuals walk with altered muscular activity, which was associated with delayed and prolonged activation of gastrocnemius muscles and sustained activation of the quadriceps muscles. This may result in sustained loading of the joint, proposed to be detrimental to joint integrity.

Following our first study on the neuromuscular patterns of major knee muscles, we implemented an electromyography driven model to incorporate the real EMG activity of knee muscles to estimate muscle forces and subsequently tibiofemoral joint contact forces. The model was validated against existing literature and then were calibrated for an asymptomatic obese and a healthy weight subject in order to find their medial, lateral, and total joint contact forces. This case study demonstrated the ability of the model to take into account the real activation patterns of the muscles in the estimation of muscle and knee joint contact forces. Furthermore, it was demonstrated the obese individual walked with higher absolute tibiofemoral joint contact forces compared to the healthy weight subject. This result will be further investigated by applying the model a large cohort with a range of BMI in the future.

Year	Entry
1996	Piazza SJ, Delp SL. The influence of muscles on knee flexion during the swing phase of gait. J Biomech. June 1996;29(6):723-733.
1998	Hurwitz DE, Sumner DR, Andriacchi TP, Sugar DA. Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech. May 1998;31(5):423-430.
2007	Erdemir A, McLean S, Herzog W, van den Bogert AJ. Model-based estimation of muscle forces exerted during movements. Clin Biomech (Bristol, Avon). February 2007;22(2):131-154.
1991	Schipplein OD, Andriacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res. January 1991;9(1):113-119.
2003	Lloyd DG, Besier TF. An EMG-driven musculoskeletal model to estimate muscle forces and knee joint moments in vivo. J Biomech. June 2003;36(6):765-776.
1987	Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly: the Framingham Osteoarthritis Study. Arthritis Rheum. August 1987;30(8):914-918.
1998	Sharma L, Hurwitz DE, Thonar EJ-MA, Sum JA, Lenz ME, Dunlop DD, Schnitzer TJ, Kirwan-Mellis G, Andriacchi TP. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis Rheum. July 1998;41(7):1233-1240.
2002	Hurwitz DE, Ryals AB, Case JP, Block JA, Andriacchi TP. The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res. January 2002;20(1):101-107.
1997	Glitsch U, Baumann W. The three-dimensional determination of internal loads in the lower extremity. J Biomech. November–December 1997;30(11-12):1123-1131.
2007	Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng. November 2007;54(11):1940-1950.
2005	Shelburne KB, Torry MR, Pandy MG. Muscle, ligament, and joint-contact forces at the knee during walking. Med Sci Sports Exer. November 2005;37(11):1948-1956.
2004	Buchanan TS, Lloyd DG, Manal K, Besier TF. Neuromusculoskeletal modeling: estimation of muscle forces and joint moments and movements from measurements of neural command. J Appl Biomech. November 2004;20(4):367-395.
2006	Shelburne KB, Torry MR, Pandy MG. Contributions of muscles, ligaments, and the ground-reaction force to tibiofemoral joint loading during normal gait. J Orthop Res. October 2006;24(10):1983-1990.
2013	Gerus P, Sartori M, Besier TF, Fregly BJ, Delp SL, Banks SA, Pandy MG, D'Lima DD, Lloyd DG. Subject-specific knee joint geometry improves predictions of medial tibiofemoral contact forces. J Biomech. November 15, 2013;46(16):2778-2786.
2012	Harding GT. Obesity, Moderate Knee Osteoarthritis, and Knee Joint Dynamics [Master's thesis]. Halifax, NS: Dalhousie University; July 2012.
2003	McLean SG, Su A, van den Bogert AJ. Development and validation of a 3-D model to predict knee joint loading during dynamic movement. J Biomech. December 2003;125(6):864-874.
2004	Andriacchi TP, Mündermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S. A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. March 2004;32(3):447-457.
1975	Seireg A, Arvikar RJ. The prediction of muscular load sharing and joint forces in the lower extremities during walking. J Biomech. March 1975;8(2):89-102.
1998	Finni T, Komi PV, Lukkariniemi J. Achilles tendon loading during walking: application of a novel optic fiber technique. Euro J Appl Physiol Occup Physiol. February 1998;77(3):289-291.
2000	Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, Sowers M, McAlindon T, Spector TD, Poole AR, Yanovski SZ, Ateshian G, Sharma L, Buckwalter JA, Brandt KD, Fries JF. Osteoarthritis: new insights, I: the disease and its risk factors. Ann Intern Med. October 17, 2000;133(8):635-646.
2006	Andriacchi TP, Mündermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rhuematol. September 2006;18(5):514-518.
1997	Burr DB, Schaffler MB. The involvement of subchondral mineralized tissues in osteoarthrosis: quantitative microscopic evidence. Microsc Res Tech. May 15, 1997;37(4):343-357.
1990	Winter DA. Biomechanics and Motor Control of Human Movement. 2nd ed. New York, NY: Inc., John Wiley & Sons; 1990.
2007	Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed. J Biomech. 2007;40(8):1754-1761.
1957	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. December 1957;16(4):494-502.
2002	Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. July 2002;61(6):617-622.
2013	Millard M, Uchida T, Seth A, Delp SL. Flexing computational muscle: modeling and simulation of musculotendon dynamics. J Biomech Eng. February 2013;135(2):021005.
2010	Arnold EM, Ward SR, Lieber RL, Delp SL. A model of the lower limb for analysis of human movement. Ann Biomed Eng. February 2010;38(2):269-279.
2009	Ward SR, Eng CM, Smallwood LH, Lieber RL. Are current measurements of lower extremity muscle architecture accurate? Clin Orthop Relat Res. April 2009;467(4):1074-1082.
2008	Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res. March 2008;26(3):332-341.
2004	McLean SG, Huang X, Su A, van den Bogert AJ. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. Clin Biomech (Bristol, Avon). October 2004;19(8):828-838.
1939	Katz B. The relation between force and speed in muscular contraction. J Physiol. June 1939;96(1):45-64.
1970	Morrison JB. The mechanics of the knee joint in relation to normal walking. J Biomech. January 1970;3(1):51-61.
1988	Walker PS, Rovick JS, Robertson DD. The effects of knee brace hinge design and placement on joint mechanics. J Biomech. 1988;21(11):965-974.
2009	Winby CR, Lloyd DG, Besier TF, Kirk TB. Muscle and external load contribution to knee joint contact loads during normal gait. J Biomech. October 16, 2009;42(14):2294-2300.
1981	Crowninshield RD, Brand RA. A physiologically based criterion of muscle force prediction in locomotion. J Biomech. 1981;14(11):793-801.
1992	Schutte LM. Using Musculoskeletal Models to Explore Strategies for Improving Performance in Electrical Stimulation-Induced Leg Cycle Ergometry [PhD thesis]. Stanford University; 1992.
1999	Anderson FC, Pandy MG. A dynamic optimization solution for vertical jumping in three dimensions. Comput Methods Biomech Biomed Eng. 1999;2(3):201-231.
2012	Fregly BJ, Besier TF, Lloyd DG, Delp SL, Banks SA, Pandy MG, D'Lima DD. Grand challenge competition to predict in vivo knee loads. J Orthop Res. April 2012;30(4):503-513.
2007	Deluzio KJ, Astephen JL. Biomechanical features of gait waveform data associated with knee osteoarthritis: an application of principal component analysis. Gait Post. January 2007;25(1):86-93.
2001	Kaufman KR, Hughes C, Morrey BF, Morrey M, An K-N. Gait characteristics of patients with knee osteoarthritis. J Biomech. July 2001;34(7):907-915.
1989	Zajac FE. Muscle and tendon: properties, models, scaling, and application to biomechanics and motor control. Crit Rev Biomed Eng. 1989;17(4):359-411.

Year

Entry

1996

Piazza SJ, Delp SL. The influence of muscles on knee flexion during the swing phase of gait. J Biomech. June 1996;29(6):723-733.

1998

Hurwitz DE, Sumner DR, Andriacchi TP, Sugar DA. Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech. May 1998;31(5):423-430.

2007

Erdemir A, McLean S, Herzog W, van den Bogert AJ. Model-based estimation of muscle forces exerted during movements. Clin Biomech (Bristol, Avon). February 2007;22(2):131-154.

1991

Schipplein OD, Andriacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res. January 1991;9(1):113-119.

2003

Lloyd DG, Besier TF. An EMG-driven musculoskeletal model to estimate muscle forces and knee joint moments in vivo. J Biomech. June 2003;36(6):765-776.