The Effect of Long-Term Strength Training on Hip and Knee Joint Loading During Gait in Individuals With Knee Osteoarthritis and Varus Alignment

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Abstract

PURPOSE: The purpose of this study was to determine if an increase in hip strength in individuals with knee varus malalignment and medial tibiofemoral osteoarthritis consequent to an 18-month strength training intervention resulted in changes in knee and hip joint loads compared to an attention control group.

METHODS: This study involved a secondary analysis of the Strength Training for Arthritis Trial (START) randomized clinical trial that determined the clinical and mechanistic effects of high intensity strength training and low intensity strength training, compared to an attention control group in people with knee OA. We stratified participants from the total population from START (n=377) based on knee malalignment and hip abductor strength to use in this analysis. From the START dataset, all individuals with ≥ 2 degrees varus alignment were included in the secondary analysis. The strength training group included only individuals who increased their hip abductor strength by 20% in addition to varus alignment. The total population after stratification for the control group and strength training group was 90 and 47 respectively. Internal moments and forces were calculated using a 3D motion capture system using 6 cameras and 2 force plates, inverse dynamics, and a biomechanical knee model. A HUMAC isokinetic dynamometer was used to calculate muscle strength. Linear regression with adjustments for baseline covariates were used to compare means between groups at 18 months for both biomechanical outcome data and strength data.

RESULTS: The strength training group had much greater increases in strength in the quadriceps (41%), hamstring (64%), and hip abductors (40%) compared to the control group (8%, 11%, and 2% respectively). There were significant differences in strength for each muscle between groups at 18-month follow-up which favored the strength training group. Even with significant increases in strength, there were no differences in the internal knee abduction moment, internal hip abduction moment, and knee compressive forces between groups at 18 months. There was a significant decrease in the internal knee extension moment for the strength training group compared to the control group at 18- month follow-up.

CONCLUSION: An 18-month strength training intervention that increased quad, hamstring, and hip abductor strength did not reduce frontal plane measures of hip and knee joint loading or knee compressive forces. The internal knee extension moment was the only surrogate measure that differed between the groups at 18-month follow-up and was significantly reduced in the strength training group. Our study suggests that long-term strength training may reduce sagittal plane knee joint loads, which may aid in reducing the total amount of load on the knee during gait in people with knee OA and varus alignment. Even with the results of this study future research is needed to evaluate the effects of strength training on hip and knee joint loading in this population.

Cited Works (21)

Year	Entry
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.
1991	Schipplein OD, Andriacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res. January 1991;9(1):113-119.
1973	Seireg A, Arvikar RJ. A mathematical model for evaluation of forces in lower extremeties of the musculo-skeletal system. J Biomech. May 1973;6(3):313-326.
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.
1992	Spoor CW, van Leeuwen JL. Knee muscle moment arms from MRI and from tendon travel. J Biomech. February 1992;25(2):201-206.
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.
1990	Yamaguchi GT, Sawa AGU, Moran DW, Fessler MJ, Winters JM. A survey of human musculotendon actuator parameters. In: Winters JM, Woo SL-Y, eds. Multiple Muscle Systems: Biomechanics and Movement Organization. New York, NY: Springer-Verlag; 1990:717-773.
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.
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.
2001	Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. July 11, 2001;286(2):188-195.
1989	Yamaguchi GT, Zajac FE. A planar model of the knee joint to characterize the knee extensor mechanism. J Biomech. 1989;22(1):1-10.
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	Lohmander LS, Östenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. October 2004;50(10):3145-3152.
1990	Rugg SG, Gregor RJ, Mandelbaum BR, Chiu L. In vivo moment arm calculations at the ankle using magnetic resonance imaging (MRI). J Biomech. 1990;23(5):495-501.
2013	Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, Beavers DP, Hunter DJ, Lyles MF, Eckstein F, Williamson JD, Carr JJ, Guermazi A, Loeser RF. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. September 25, 2013;310(12):1263-1273.
2011	Messier SP, Legault C, Loeser RF, Van Arsdale SJ, Davis C, Ettinger WH, DeVita P. Does high weight loss in older adults with knee osteoarthritis affect bone-on-bone joint loads and muscle forces during walking? Osteoarthritis Cartilage. March 2011;19(3):272-280.
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.
1964	Hanavan EP Jr. A Mathematical Model of the Human Body. Wright-Patterson AFB, OH: Air Force Aerospace Medical Research Lab; October 1964. Technical Report AMRL-TR-64-100.