Alterations in Joint Loading and Muscle Coordination Strategies With the Progression of Medial Compartment Knee Osteoarthritis

Links

Abstract

Osteoarthritis (OA) is one of the leading causes of disability in the nation. With an increase in the middle age and elderly population, arthritis-related disability is expected to dramatically increase in the coming years. The mechanically initiated progression of the disease may stem from alterations in joint kinetics, kinematics and muscular control. The purpose of this work was to examine multiple facets of human gait that may contribute to altered joint loading and in turn, the progression of arthritis. This was addressed through four studies. In order to discern how persons with knee OA can decrease contribution of the knee to support during walking, the first study analyzed the contribution from ipsilateral joints to the total support moment. The results suggested that adaptive strategies are related to self-selected walking speed and involve a reduction of the knee contribution to support moment with a subsequent increase in ankle and hip contribution. The second study aimed to determine how differences in walking patterns affect a multitude of gait variables that have been previously associated with abnormal or detrimental joint loading. We attempted to differentiate between the adaptive gait strategies associated with alterations in walking speed and strategies that were an inherent part of the disease progression. The results from this study suggest that the selection of a slower self-selected walking speed reduces joint loading and appears to be a beneficial gait strategy, however certain potentially detrimental gait alterations exist regardless of freely chosen walking speed. The third study evaluated the effect of neuromuscular control on joint loading. Higher antagonistic muscle activity results in higher intersegmental forces. Analysis of muscular contribution to abnormal joint loading provides information beyond alterations in joint kinematics and kinetics. It was found that subjects with knee OA utilize higher co-contraction and potentially higher muscle forces during walking. The final study evaluated the potential end effect of alterations in muscular control on the dynamic joint stiffness in the knee during walking. Subjects with severe OA had higher levels of dynamic joint stiffness during walking than persons with less severe OA or persons without radiographic evidence of the disease. From these studies we have drawn two overall conclusions: 1) persons with knee OA exploit slower freely chosen walking speeds to reduce joint loading and 2) certain variables associated with detrimental effects on joint integrity cannot be reduced through the reduction of walking speed. This work should be used as the basis for future longitudinal studies which will help determine the effect of altered loading on joint progression and lead to rehabilitative strategies to reduce the progression of the disease.

Cited Works (22)

Year	Entry
1992	Perry J. Gait Analysis: Normal and Pathological Function. Thorofare, NJ: SLACK Incorporated; 1992.
2005	Griffin TM, Guilak F. The role of mechanical loading in the onset and progression of osteoarthritis. Exerc Sport Sci Rev. October 2005;33(4):195-200.
2000	DeVita P, Hortobagyi T. Age causes a redistribution of joint torques and powers during gait. J Appl Physiol. May 2000;88(5):1804-1811.
1999	Setton LA, Elliott D., Mow VC. Altered mechanics of cartilage with osteoarthritis: human osteoarthritis and an experimental model of joint degeneration. Osteoarthritis Cartilage. January 1999;7(1):2-14.
2003	Anderson FC, Pandy MG. Individual muscle contributions to support in normal walking. Gait Post. April 2003;17(2):159-169.
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.
2007	Zhao D, Banks SA, Mitchell KH, D'Lima DD, Colwell CW Jr, Fregly BJ. Correlation between the knee adduction torque and medial contact force for a variety of gait patterns. J Orthop Res. June 2007;25(6):789-797.
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.
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.
2002	Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, Andriacchi TP. Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis Cartilage. July 2002;10(7):573-579.
1997	Kepple TM, Siegel KL, Stanhope SJ. Relative contributions of the lower extremity joint moments to forward progression and support during gait. Gait Post. August 1997;6(1):1-8.
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.
1997	De Luca CJ. The use of surface electromyography in biomechanics. J Appl Biomech. May 1997;13(2):135-163.
1981	Crowninshield RD, Brand RA. A physiologically based criterion of muscle force prediction in locomotion. J Biomech. 1981;14(11):793-801.
2007	Riley PO, Paolini G, Della Croce U, Paylo KW, Kerrigan DC. A kinematic and kinetic comparison of overground and treadmill walking in healthy subjects. Gait Post. 2007;26(1):17-24.
1990	Delp SL, Loan JP, Hoy MG, Zajac FE, Topp EL, Rosen JM. An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng. 1990;37(8):757-767.
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.
1980	Winter DA. Overall principle of lower limb support during stance phase of gait. J Biomech. 1980;13(11):923-927.
2006	Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. January 2006;54(1):226-229.
2008	Zeni JA Jr, Richards JG, Higginson JS. Two simple methods for determining gait events during treadmill and overground walking using kinematic data. Gait Post. May 2008;27(4):710-714.