Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis

wbldb

Sharma, Leena¹; Hurwitz, Debra E.²; Thonar, Eugene J-M. A.²; Sum, Jeffrey A.²; Lenz, Mary Ellen²; Dunlop, Dorothy D.¹; Schnitzer, Thomas J.¹; Kirwan-Mellis, Gretchen¹; Andriacchi, Thomas P.²

Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis

Arthritis Rheum. July 1998;41(7):1233-1240

©1998 AmeriLdn College of Rheumatology

Affiliations

¹Northwestern University, Chicago, Illinois

²Rush Medical College at Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois
Abstract

Objective: The adduction moment at the knee during gait is the primary determinant of medial-tolateral load distribution. If the adduction moment contributes to progression of osteoarthritis (OA), then patients with advanced medial tibiofemoral OA should have higher adduction moments. The present study was undertaken to investigate the hypothesis that the adduction moment normalized for weight and height is associated with medial tibiofemoral OA disease severity after controlling for age, sex, and pain level, and to examine the correlation of serum hyaluronan (HA) level with disease severity and with the adduction moment in a subset of patients.

Methods: Fifty-four patients with medial tibiofemoral OA underwent gait analysis and radiographic evaluation. Disease severity was assessed using the Kellgren-Lawrence (K-L) grade and medial joint space width. In a subset of 23 patients with available sera, HA was quantified by sandwich enzyme-linked immunosorbent assay. Pearson correlations, a random effects model, and multivariate regression models were used.

Results: The adduction moment correlated with the K-L grade in the left and right knees (r = 0.68 and r = 0.60, respectively), and with joint space width in the left and right knees (r = -0.45 and r = -0.47, respectively). The relationship persisted after controlling for age, sex, and severity of pain. The partial correlation between K-L grade and adduction moment was 0.71 in the left knees and 0.61 in the right knees. For every 1.0-unit increase in adduction moment, there was a 0.63-mm decrease in joint space width. In the subset of patients in whom serum HA levels were measured, HA levels correlated with medial joint space width (r = -0.55), but not with the adduction moment.

Conclusion: There is a significant relationship between the adduction moment and OA disease severity. Serum HA levels correlate with joint space width but not with the adduction moment. Longitudinal studies will be necessary to determine the contribution of the adduction moment, and its contribution in conjunction with metabolic markers, to progression of medial tibiofemoral OA.
Links

DOI: 10.1002/1529-0131(199807)41:7<1233::AID-ART14>3.0.CO;2-L

PubMed: 9663481

WoS: 000074585400013
History

Accepted: 1998-01-30
Cited Works (1)

Year Entry

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

Cited By (59)

Year	Entry
2010	Wannop JW, Worobets JT, Stefanyshyn DJ. Footwear traction and lower extremity joint loading. Am J Sports Med. 2010;38(6):1221-1228.
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.
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.
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	Zajac FE, Neptune RR, Kautz SA. Biomechanics and muscle coordination of human walking, I: introduction to concepts, power transfer, dynamics and simulations. Gait Post. December 2002;16(3):215-232.
2003	Zajac FE, Neptune RR, Kautz SA. Biomechanics and muscle coordination of human walking, II: lessons from dynamical simulations and clinical implications. Gait Post. February 2003;17(1):1-17.
2007	Fregly BJ, Reinbolt JA, Rooney KL, Mitchell KH, Chmielewski TL. Design of patient-specific gait modifications for knee osteoarthritis rehabilitation. IEEE Trans Biomed Eng. September 2007;54(9):1687-1695.
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.
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.
2015	Lerner ZF, DeMers MS, Delp SL, Browning RC. How tibiofemoral alignment and contact locations affect predictions of medial and lateral tibiofemoral contact forces. J Biomech. February 26, 2015;48(4):644-650.
2023	Kaneda JM, Seagers KA, Uhlrich SD, Kolesar JA, Thomas KA, Delp SL. Can static optimization detect changes in peak medial knee contact forces induced by gait modifications? J Biomech. May 2023;152:111569.
2023	Sacco ICN, Trombini-Souza F, Suda EY. Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: a 50-year perspective. J Biomech. June 2023;154:111604.
2009	Andriacchi TP, Koo S, Scanlan SF. Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. J Bone Joint Surg. February 2009;91A(suppl 1):95-101.
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.
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.
2022	Teoli A, Cloutier-Gendron M, Ho SYK, Gu S, Pelletier J-P, Martel-Pelletier J, Robbins SM. The relationship between knee loading during gait and cartilage thickness in nontraumatic and posttraumatic knee osteoarthritis. J Orthop Res. August 2022;40(8):1778-1786.
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.
2002	Astephen JL. A Multidimensional Analysis Technique for Discriminating Between Normal and Knee Osteoarthritic Gait Patterns [Master's thesis]. Halifax, NS: Dalhousie University; July 2002.
2007	Astephen JL. Biomechanical Factors in the Progression of Knee Osteoarthritis [PhD thesis]. Halifax, NS: Dalhousie University; October 2007.
2011	Conrad J. The Biomechanical Effects of an Externally Applied Orthosis on Medial Compartment Knee Osteoarthritis [Master's thesis]. Halifax, NS: Dalhousie University; December 2011.
2012	Harding GT. Obesity, Moderate Knee Osteoarthritis, and Knee Joint Dynamics [Master's thesis]. Halifax, NS: Dalhousie University; July 2012.
2013	Konadu DK. An Insight Into Implant Failure Through Inducible Displacement and Gait Analysis in Total Knee Replacements [Master's thesis]. Halifax, NS: Dalhousie University; May 2013.
2014	Amiri P. Obesity and Its Influence on Knee Joint Contact Forces in Individuals With Moderate Knee Osteoarthritis [Master's thesis]. Halifax, NS: Dalhousie University; August 2014.
2010	Stevermer CA. Functional Movement Assessment for Individuals With Knee Osteoarthritis [PhD thesis]. Iowa State University; 2010.
2014	Lathrop RL. Investigation of Measurable Biomechanical Factors That May Influence Articular Cartilage Degeneration in the Knee [PhD thesis]. The Ohio State University; 2014.
2015	Freisinger GM. Varus-Valgus Knee Laxity and Biomechanical Function in Patients With Severe Osteoarthritis and After Total Knee Arthroplasty [PhD thesis]. The Ohio State University; 2015.
2015	Lewis JM. Factors That Affect a Patient's Stair Climbing Ability Before and After Total Knee Arthroplasty [PhD thesis]. The Ohio State University; 2015.
2017	Caruthers EJ. Investigating Lower Limb Muscle Function During the Sit to Stand Transfer and Stair Climbing [PhD thesis]. The Ohio State University; 2017.
2009	Brandon SCE. The Effects of Alternative Joint Models in the Study of Lower-Limb Joint Moments in Knee Osteoarthritis [Master's thesis]. Queen's University; July 2009.
2009	Linley HS. Trunk Lean in Control and Osteoarthritic Gait [Master's thesis]. Queen's University; August 2009.
2016	Hassan EA. Multivariate Techniques in Biomechanical Analysis [PhD thesis]. Queen's University; August 2016.
2018	Clouthier AL. The Relationship Between Knee Joint Shape and Function: Implications for Pathology and Treatment [PhD thesis]. Queen's University; September 2018.
2018	Neville SR. Methods for Improving Ability to Investigate the Effectiveness of Non-Invasive Treatment Strategies for Medial Knee OA [Master's thesis]. Queen's University; September 2018.
2005	Gushue DL. Frontal Plane Knee Joint Biomechanics: Implications in Experimental Animal Models and Childhood Obesity [PhD thesis]. University of Rochester; 2005.
2009	Lancianese SL. Modeling the Effect of Obesity and Related Biomechanical Risk Factors on the Onset of Knee Osteoarthritis [PhD thesis]. University of Rochester; 2009.
2006	Thorp LE. The Relationship Between Structure and Function in Knee Osteoarthritis: A Mechanical Perspective Utilizing Gait Analysis [PhD thesis]. Rush University; 2006.
2005	Fisher DS. Methods to Systematically Change the Patterns of Gait Associated With Osteoarthritis At the Knee [PhD thesis]. Stanford University; July 2005.
2006	Koo S. Variations in Knee Articular Cartilage Morphology Are Associated With Biomechanics of Gait for Healthy, Osteoarthritic and ACL Deficient Subjects [PhD thesis]. Stanford University; September 2006.
2008	Erhart JC. Efficacy of a Variable -Stiffness Footwear Intervention for Treatment of Medial Compartment Knee Osteoarthritis [PhD thesis]. Stanford University; November 2008.
2010	Netravali NA. Meniscal Damage, Partial Medial Meniscectomy, and the Development of Osteoarthritis [PhD thesis]. Stanford University; November 2010.
2013	Zabala M. The Effects of ACL Injury on Gait Mechanics and the Initiation of Osteoarthritis [PhD thesis]. Stanford University; June 2013.
2015	DeMers MS. Computer Modeling of Muscle Coordination Strategies That Decrease Joint Loads [PhD thesis]. Stanford University; December 2015.
2016	Chehab EF. Understanding the Pathogenesis of Age-Related Knee Osteoarthritis [PhD thesis]. Stanford University; November 2016.
2020	Uhlrich SD. Gait Modifications for Knee Osteoarthritis: Design, Evaluation, and Clinical Translation [PhD thesis]. Stanford University; August 2020.
2021	Thomas KA. Deep Learning Tools to Accelerate Knee Osteoarthritis Research [PhD thesis]. Stanford University; August 2021.
2019	Wayne CA. The Effect of Body Mass Index on the Biomechanics Before and After Total Knee Arthroplasty [Master's thesis]. Edmonton, AB: University of Alberta; 2019.
2004	Scovil CY. The Viability of a 3D Forward Dynamic Model of Walking as a Research Tool to Enhance Clinical Understanding of Gait Abnormalities [PhD thesis]. Calgary, AB: University of Calgary; March 2004.
2008	Park SK. The Influence of Knee Joint Laxity and Hormones on Dynamic Joint Function in Healthy Females [PhD thesis]. Calgary, AB: University of Calgary; August 2008.
2010	Tapper JE. Dynamic in Vivo Kinematics in an Ovine Stifle Joint Model of Osteoarthritis [PhD thesis]. Calgary, AB: University of Calgary; March 2010.
2012	Beveridge JE. Surface Interactions and Cartilage Damage in Two Ovine Models of Stifle Injury [PhD thesis]. Calgary, AB: University of Calgary; April 2012.
2012	Wannop JW. Footwear Traction and Lower Extremity Non-Contact Injury [PhD thesis]. Calgary, AB: University of Calgary; August 2012.
2016	Lewinson RT. Prescription of Specialized Footwear for Individuals With Knee Osteoarthritis [PhD thesis]. Calgary, AB: University of Calgary; January 2016.
2009	Barrios JA IV. A Biomechanical Assessment of Young, Asymptomatic Individuals With Varus Knee Alignment: Can Gait Retraining be Beneficial? [PhD thesis]. University of Delaware; Winter 2009.
2006	Zhao D. Analysis of in Vitro and in Vivo Function of Total Knee Replacements Using Dynamic Contact Models [PhD thesis]. University of Florida; August 2006.
2017	Jacobs BY. Pathologic Gait in Osteoarthritis Models: Characterization and Treatment [PhD thesis]. University of Florida; December 2017.
2011	Fey NP. The Influence of Prosthetic Foot Design and Walking Speed on Below-Knee Amputee Gait Mechanics [PhD thesis]. University of Texas at Austin; December 2011.
2017	Schlotman TE. Dynamic Simulation and Analysis of Gait Modification for Treating Knee Osteoarthritis [PhD thesis]. Knoxville, University of Tennessee; May 2017.
2017	Thompson RL. Musculoskeletal Loads During Stationary Cycling and the Effects of Pedal Modifications for Knee Osteoarthritis [PhD thesis]. Knoxville, University of Tennessee; May 2017.