1
|
Hussain I, Kim SE, Kwon C, Hoon SK, Kim HC, Ku Y, Ro DH. Estimation of patient-reported outcome measures based on features of knee joint muscle co-activation in advanced knee osteoarthritis. Sci Rep 2024; 14:12428. [PMID: 38816528 PMCID: PMC11139965 DOI: 10.1038/s41598-024-63266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
Electromyography (EMG) is considered a potential predictive tool for the severity of knee osteoarthritis (OA) symptoms and functional outcomes. Patient-reported outcome measures (PROMs), such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), are used to determine the severity of knee OA. We aim to investigate muscle activation and co-contraction patterns through EMG from the lower extremity muscles of patients with advanced knee OA patients and evaluate the effectiveness of an interpretable machine-learning model to estimate the severity of knee OA according to the WOMAC (pain, stiffness, and physical function) and VAS using EMG gait features. To explore neuromuscular gait patterns with knee OA severity, EMG from rectus femoris, medial hamstring, tibialis anterior, and gastrocnemius muscles were recorded from 84 patients diagnosed with advanced knee OA during ground walking. Muscle activation patterns and co-activation indices were calculated over the gait cycle for pairs of medial and lateral muscles. We utilized machine-learning regression models to estimate the severity of knee OA symptoms according to the PROMs using muscle activity and co-contraction features. Additionally, we utilized the Shapley Additive Explanations (SHAP) to interpret the contribution of the EMG features to the regression model for estimation of knee OA severity according to WOMAC and VAS. Muscle activity and co-contraction patterns varied according to the functional limitations associated with knee OA severity according to VAS and WOMAC. The coefficient of determination of the cross-validated regression model is 0.85 for estimating WOMAC, 0.82 for pain, 0.85 for stiffness, and 0.85 for physical function, as well as VAS scores, utilizing the gait features. SHAP explanation revealed that greater co-contraction of lower extremity muscles during the weight acceptance and swing phases indicated more severe knee OA. The identified muscle co-activation patterns may be utilized as objective candidate outcomes to better understand the severity of knee OA.
Collapse
Affiliation(s)
- Iqram Hussain
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Department of Anesthesiology, Weill Cornell Medicine, Cornell University, New York, NY, 10065, USA
| | - Sung Eun Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Chiheon Kwon
- Medical Device Research Center, Department of Biomedical Research Institute, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Seo Kyung Hoon
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Hee Chan Kim
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Republic of Korea
| | - Yunseo Ku
- Medical Device Research Center, Department of Biomedical Research Institute, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea.
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- CONNECTEVE Co., Ltd, Seoul, 06224, Republic of Korea.
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| |
Collapse
|
2
|
Kirschbaum S, Hube R, Perka C, Najfeld M. Bilateral simultaneous knee arthroplasty shows comparable early outcome and complication rate as staged bilateral knee arthroplasty for patients scored ASA 1-3 if performed by a high-volume surgeon: a retrospective cohort study of 127 cases. Arch Orthop Trauma Surg 2024; 144:417-424. [PMID: 37814008 PMCID: PMC10774180 DOI: 10.1007/s00402-023-05078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND PURPOSE The study compares early outcomes after simultaneous and staged knee arthroplasty in patients with bilateral knee osteoarthritis (OA) to evaluate whether simultaneous bilateral TKA shows comparable early outcomes and complication rates to staged bilateral TKA. METHODS A retrospective cohort study including all patients scheduled for primary TKA for bilateral knee OA (n = 127) was conducted. Patients received either simultaneous (n = 53, 41.7%) or staged (n = 74, 58.3%) bilateral TKA by a single, high-volume surgeon-depending on their individual preference. Demographic data, haemoglobin drop (Hb), length of stay (LOS), operation time, 30-day complication rate and achievement of rehabilitation key points were evaluated. RESULTS There was no difference between the groups concerning age, sex, BMI or complication rate. ASA scoring was better in the simultaneous group [2.2, (15.1% ASA 1, 49.1% ASA 2, 35.8% ASA 3) vs. 2.4 (2.7% ASA 1, 51.4% ASA 2, 45.9% ASA 3)]. Average LOS was 7.8 ± 2.1 days for simultaneous TKA, 7.4 ± 1.7 days for single procedure of staged group (p < 0.453) and 14.7 ± 3.1 days if combined (p < 0.001). Cumulative Hb loss was significantly higher in the staged group (3.8 ± 1.2 g/dl vs. 2.4 ± 0.8 g/dl, p < 0.001). Detailed comparison of early outcome parameters between staged and simultaneous procedure depending on ASA score only revealed slightly slower assessment of stairs (p < 0.001) and increased Hb drop per surgery in case of simultaneous procedure (p < 0.011) if ASA score was ≥ 2. Only patients scored ASA 3 demonstrated a significant longer LOS per procedure in simultaneous group (8.5 ± 2.4 vs.7.3 ± 1.6 days, p = 0.034). INTERPRETATION Simultaneous bilateral TKA results in comparable early outcome and complication rate than staged bilateral procedure-even for patients scored ASA 3. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Stephanie Kirschbaum
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Hube
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Najfeld
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
| |
Collapse
|
3
|
Liu S, Amiri P, McGregor AH, Bull AMJ. Bilateral Asymmetry in Knee and Hip Musculoskeletal Loading During Stair Ascending/Descending in Individuals with Unilateral Mild-to-Moderate Medial Knee Osteoarthritis. Ann Biomed Eng 2023; 51:2490-2503. [PMID: 37482575 PMCID: PMC10598163 DOI: 10.1007/s10439-023-03289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
Most cases of unilateral knee osteoarthritis (OA) progress to bilateral OA within 10 years. Biomechanical asymmetries have been implicated in contralateral OA development; however, gait analysis alone does not consistently detect asymmetries in OA patient gait. Stair ambulation is a more demanding activity that may be more suited to reveal between-leg asymmetries in OA patients. The objective of this study was to investigate the between-leg biomechanical differences in patients with unilateral mild-to-moderate knee OA. Sixteen unilateral mild-to-moderate medial knee OA patients and 16 healthy individuals underwent kinematic and kinetic analysis of stair ascent and descent. Stair ascent produced higher loading and muscle forces in the unaffected limb compared to the OA limb, and stair descent produced lower loading on the OA limb compared to healthy subjects. These biomechanical differences were apparent in the ankle, knee, and hip joints. The implications of these findings are that OA patients rely more heavily on their unaffected sides than the affected side in stair ascent, a strategy that may be detrimental to the unaffected joint health. The reduction in affected limb loading in stair descent is thought to be related to minimizing pain.
Collapse
Affiliation(s)
- Sirui Liu
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK.
| | - Pouya Amiri
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
| |
Collapse
|
4
|
Ritter J, Menger M, Herath SC, Histing T, Kolbenschlag J, Daigeler A, Heinzel JC, Prahm C. Translational evaluation of gait behavior in rodent models of arthritic disorders with the CatWalk device - a narrative review. Front Med (Lausanne) 2023; 10:1255215. [PMID: 37869169 PMCID: PMC10587608 DOI: 10.3389/fmed.2023.1255215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Arthritic disorders have become one of the main contributors to the global burden of disease. Today, they are one of the leading causes of chronic pain and disability worldwide. Current therapies are incapable of treating pain sufficiently and preventing disease progression. The lack of understanding basic mechanisms underlying the initiation, maintenance and progression of arthritic disorders and related symptoms represent the major obstacle in the search for adequate treatments. For a long time, histological evaluation of joint pathology was the predominant outcome parameter in preclinical arthritis models. Nevertheless, quantification of pain and functional limitations analogs to arthritis related symptoms in humans is essential to enable bench to bedside translation and to evaluate the effectiveness of new treatment strategies. As the experience of pain and functional deficits are often associated with altered gait behavior, in the last decades, automated gait analysis has become a well-established tool for the quantitative evaluation of the sequalae of arthritic disorders in animal models. The purpose of this review is to provide a detailed overview on the current literature on the use of the CatWalk gait analysis system in rodent models of arthritic disorders, e.g., Osteoarthritis, Monoarthritis and Rheumatoid Arthritis. Special focus is put on the assessment and monitoring of pain-related behavior during the course of the disease. The capability of evaluating the effect of distinct treatment strategies and the future potential for the application of the CatWalk in rodent models of arthritic disorders is also addressed in this review. Finally, we discuss important consideration and provide recommendations on the use of the CatWalk in preclinical models of arthritic diseases.
Collapse
Affiliation(s)
- Jana Ritter
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Maximilian Menger
- Department of Trauma and Reconstructive Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Steven C Herath
- Department of Trauma and Reconstructive Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Johannes C Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
5
|
Dai J, Jin X, Ma JX, Wu YF, Lu B, Bai HH, Ma XL. Spatiotemporal and kinematic gait analysis in patients with knee osteoarthritis and femoral varus deformity. Gait Posture 2023; 105:158-162. [PMID: 37573760 DOI: 10.1016/j.gaitpost.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is commonly combined with the presentation of a coronal deformity of the knee. The bony origin of the knee varus deformity can be classified as tibial origin, femoral origin, or a combination of tibial and femoral causes. Deformities of tibial origin are mostly common clinically, while patients with knee OA with femoral varus deformity are less common. RESEARCH QUESTION Do hip, knee and ankle kinematics and spatiotemporal parameters differ between patients with knee OA with femoral varus deformity and healthy subjects? METHODS Twenty-five patients (14 females and 11 males) with knee OA and femoral varus deformity and 20 healthy subjects (12 males and 8 females) as control group were included in this study. The kinematic parameters of the hip-knee-ankle joint and spatiotemporal gait parameters were included in the study. RESULTS This study found that the step speed and step length of the knee OA with femoral varus (KOAF) group were smaller than those of the control group, while double support period percentage was greater in the KOAF group. Significant differences were found in the maximum knee extension angle, maximum knee flexion angle, knee flexion range of motion, maximum hip flexion angle, maximum hip extension angle, and hip flexion range of motion between the two groups. After comparing the ankle motion between the two groups, significant differences were found in the maximum eversion angle, inversion range of motion, maximum ankle abduction angle, and abduction range of motion. SIGNIFICANCE Knee OA with femoral varus deformity causes adaptive changes in the kinematic parameters of hip, knee and ankle joints and spatiotemporal gait parameters to alleviate symptoms and maintain normal activity.
Collapse
Affiliation(s)
- Jing Dai
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China; Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Xin Jin
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China
| | - Jian-Xiong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China.
| | - Yan-Fei Wu
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China; Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Bin Lu
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China
| | - Hao-Hao Bai
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China
| | - Xin-Long Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China; Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China.
| |
Collapse
|
6
|
Warmink K, Rios JL, van Valkengoed DR, Vinod P, Korthagen NM, Weinans H. Effects of different obesogenic diets on joint integrity, inflammation and intermediate monocyte levels in a rat groove model of osteoarthritis. Front Physiol 2023; 14:1211972. [PMID: 37520829 PMCID: PMC10372350 DOI: 10.3389/fphys.2023.1211972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction: Obesogenic diets aggravate osteoarthritis (OA) by inducing low-grade systemic inflammation, and diet composition may affect OA severity. Here, we investigated the effect of diet on joint damage and inflammation in an OA rat model. Methods: Wistar-Han rats (n = 24) were fed a chow, a high-fat (HF) diet, or a high-fat/high-sucrose (HFS) for 24 weeks. OA was induced unilaterally 12 weeks after the diet onset by groove surgery, and compared to sham surgery or no surgical intervention (contralateral limb). Knee OA severity was determined by OARSI histopathology scoring system. At several timepoints monocyte populations were measured using flow cytometry, and joint macrophage response was determined via CD68 immunohistochemistry staining. Results: Groove surgery combined with HF or HFS diet resulted in higher OARSI scores, and both HF and HFS diet showed increased circulating intermediate monocytes compared to chow fed rats. Additionally, in the HFS group, minimal damage by sham surgery resulted in an increased OARSI score. HFS diet resulted in the largest metabolic dysregulation, synovial inflammation and increased CD68 staining in tibia epiphysis bone marrow. Conclusion: Obesogenic diets resulted in aggravated OA development, even with very minimal joint damage when combined with the sucrose/fat-rich diet. We hypothesize that diet-induced low-grade inflammation primes monocytes and macrophages in the blood, bone marrow, and synovium, resulting in joint damage when triggered by groove OA inducing surgery. When the metabolic dysregulation is larger, as observed here for the HFS diet, the surgical trigger required to induce joint damage may be smaller, or even redundant.
Collapse
Affiliation(s)
- K. Warmink
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - J. L. Rios
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - D. R. van Valkengoed
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - P. Vinod
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - N. M. Korthagen
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
- Department of Equine Sciences, Utrecht University, Utrecht, Netherlands
| | - H. Weinans
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
- Department of Biomechanical Engineering, TU Delft, Delft, Netherlands
| |
Collapse
|
7
|
Anwar SFZ, Wang Y, Raza W, Arnold G, Wang W. Mechanical energy fluctuation in lower limbs during walking in participants with and without total hip replacement. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230041. [PMID: 36866080 PMCID: PMC9974294 DOI: 10.1098/rsos.230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/15/2023] [Indexed: 05/13/2023]
Abstract
Mechanical energy fluctuation of the segments of lower limbs during walking has not been fully investigated. It was hypothesized that the segments may work as a pendulum, i.e. the kinetic and potential energies exchanged out of phase. This study aimed to investigate energy changes and recovery during gait in hip replacement patients. The gait data for 12 participants with total hip replacement and 12 age-matched control was compared. The kinetic, potential and rotative energies for whole lower limb and thigh, calf and foot, were calculated. The effectiveness of a pendulum effect was analysed. Gait parameters (speeds and cadence) were calculated. The results showed that the thigh had significant effectiveness as a pendulum during gait with energy recovery coefficient of approximately 40% while the calf and foot were less like a pendulum during gait. In comparison, energy recoveries of lower limbs in the two groups were not significantly different. If the pelvis was considered as an approximate to the centre of mass, however, the control group had a higher energy recovery than total-hip-replacement group by roughly 10%. This study concluded that, unlike centre of mass energy recovery, the mechanical energy recovery mechanism in the lower limbs during walking is not affected after total hip replacement.
Collapse
Affiliation(s)
- St. Fatimah Zahrah Anwar
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Ying Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Wasim Raza
- Department of Biomedical Engineering, NED University of Engineering and Technology, LEJ Campus, Karachi, Pakistan
| | - Graham Arnold
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Weijie Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| |
Collapse
|
8
|
Anwar SFZ, Wang Y, Raza W, Arnold G, Wang W. Mechanical energy fluctuation in lower limbs during walking in participants with and without total hip replacement. ROYAL SOCIETY OPEN SCIENCE 2023. [PMID: 36866080 DOI: 10.5061/dryad.r4xgxd2fr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Mechanical energy fluctuation of the segments of lower limbs during walking has not been fully investigated. It was hypothesized that the segments may work as a pendulum, i.e. the kinetic and potential energies exchanged out of phase. This study aimed to investigate energy changes and recovery during gait in hip replacement patients. The gait data for 12 participants with total hip replacement and 12 age-matched control was compared. The kinetic, potential and rotative energies for whole lower limb and thigh, calf and foot, were calculated. The effectiveness of a pendulum effect was analysed. Gait parameters (speeds and cadence) were calculated. The results showed that the thigh had significant effectiveness as a pendulum during gait with energy recovery coefficient of approximately 40% while the calf and foot were less like a pendulum during gait. In comparison, energy recoveries of lower limbs in the two groups were not significantly different. If the pelvis was considered as an approximate to the centre of mass, however, the control group had a higher energy recovery than total-hip-replacement group by roughly 10%. This study concluded that, unlike centre of mass energy recovery, the mechanical energy recovery mechanism in the lower limbs during walking is not affected after total hip replacement.
Collapse
Affiliation(s)
- St Fatimah Zahrah Anwar
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Ying Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Wasim Raza
- Department of Biomedical Engineering, NED University of Engineering and Technology, LEJ Campus, Karachi, Pakistan
| | - Graham Arnold
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Weijie Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| |
Collapse
|
9
|
Ghazwan A, Wilson C, Holt CA, Whatling GM. Knee osteoarthritis alters peri-articular knee muscle strategies during gait. PLoS One 2022; 17:e0262798. [PMID: 35051232 PMCID: PMC8775536 DOI: 10.1371/journal.pone.0262798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
The primary role of muscles is to move, and control joints. It is therefore important to understand how degenerative joint disease changes this role with the resulting effect on mechanical joint loading. Muscular control strategies can vary depending on strength and coordination which in turn influences joint control and loading. The purpose of this study was to investigate the variation in neuromuscular control mechanisms and joint biomechanics for three subject groups including those with: uni-compartmental knee osteoarthritis (OA), listed for high tibial osteotomy surgery (pre-HTO, n = 10); multi-compartmental knee OA listed for total knee replacement (pre-TKR, n = 9), and non-pathological knees (NP, n = 11). Lower limb kinematics and electromyography (EMG) data for subjects walking at self-selected speed, were input to an EMG-driven musculoskeletal knee model which was scaled and calibrated to each individual to estimate muscle forces. Compared to NP, the peak gastrocnemius muscle force reduced by 30% and 18% for pre-HTO and pre-TKR respectively, and the peak force estimated for hamstring muscle increased by 25% for pre-HTO. Higher quadriceps and hamstring forces suggest that co-contraction with the gastrocnemius could lead to higher joint contact forces. Combined with the excessive loading due to a high external knee adduction moment this may exacerbate joint destruction. An increased lateral muscle co-contraction reflects the progression from NP to uni-compartmental OA (pre-HTO). Pre-TKR patients adopt a different gait pattern to pre-HTO patients. Increased medial muscle co-activation could potentially differentiate between uni- or multi-compartmental OA.
Collapse
Affiliation(s)
- Aseel Ghazwan
- Cardiff School of Engineering, College of Physical Sciences and Engineering, Cardiff University, Cardiff, United Kingdom
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
- Biomedical Engineering Department, College of Engineering, Al-Nahrain University, Baghdad, Iraq
- * E-mail:
| | - Chris Wilson
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
- University Hospital of Wales, Cardiff, United Kingdom
| | - Cathy A. Holt
- Cardiff School of Engineering, College of Physical Sciences and Engineering, Cardiff University, Cardiff, United Kingdom
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
| | - Gemma M. Whatling
- Cardiff School of Engineering, College of Physical Sciences and Engineering, Cardiff University, Cardiff, United Kingdom
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
10
|
Pereira LC, Runhaar J, Favre J, Jolles BM, Bierma-Zeinstra S. Association between changes in the knee adduction moment and changes in knee pain and function in response to non-surgical biomechanical interventions for medial knee osteoarthritis: a systematic review. Eur J Phys Rehabil Med 2021; 57:948-958. [PMID: 34468109 DOI: 10.23736/s1973-9087.21.06828-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is lack of understanding of the relationship between knee adduction moment (KAM) reductions and improvements in pain or function in patients with knee osteoarthritis (KOA). Moreover, there is no systematic review describing the longitudinal relationship between KAM changes and subsequent changes in pain and/or physical function. We aimed (1) to investigate the relationship between changes in KAM induced by non-surgical biomechanical interventions and consecutive changes in pain and/or physical function in patients with medial KOA and (2) to compare this relationship for different interventions. We considered eligible all RCTs using biomechanical interventions aimed to reduce KAM in KOA patients, that measured pain/function. We used Cohen's d effect size to quantify outcome measurements. 14 papers reporting 11 studies were identified. Braces were tested in 6 studies, insoles in 5 studies, shoes in 3 studies and gait retraining in 2 studies. Methodological differences were large among studies. Large effect sizes (≥0.8) changes in pain/function were observed with interventions having at least a small KAM effect size (≥0.2), suggesting an association between KAM and pain/function changes. A linear trend was observed between inter-intervention KAM and VAS pain effect sizes, based on 4 studies. No firm conclusions could be drawn for the different intervention types. There was a trend toward larger KAM reductions leading to larger improvements in pain/function in non-surgical biomechanical interventions. Additional high-quality RCT with consistent methodology are needed to fully characterize the association between KAM and pain/function changes.
Collapse
Affiliation(s)
- Luis C Pereira
- Departement of Musculoskeletal Medicine (DAL), Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland -
| | - Jos Runhaar
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julien Favre
- Departement of Musculoskeletal Medicine (DAL), Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Brigitte M Jolles
- Departement of Musculoskeletal Medicine (DAL), Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland.,Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | |
Collapse
|
11
|
Santana-Pineda MM, Vanlinthout LE, Santana-Ramírez S, Vanneste T, Van Zundert J, Novalbos-Ruiz JP. A Randomized Controlled Trial to Compare Analgesia and Functional Improvement After Continuous Neuroablative and Pulsed Neuromodulative Radiofrequency Treatment of the Genicular Nerves in Patients with Knee Osteoarthritis up to One Year After the Intervention. PAIN MEDICINE 2021; 22:637-652. [PMID: 33179073 DOI: 10.1093/pm/pnaa309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare the analgesic and functional outcomes of continuous neuroablative radiofrequency (CNARF) and pulsed neuromodulative radiofrequency (PNMRF) treatment of genicular nerves up to 1 year after the intervention and to identify predictors associated with a successful outcome (defined as an at least 50% reduction in the pre-interventional visual analog scale [VAS] rating) after genicular radiofrequency treatment. DESIGN A prospective randomized controlled trial. SETTING The Pain Department of the Jerez de la Frontera University Hospital, Cadíz, Spain, from January 2018 until May 2019. SUBJECTS Patients with grade 3-4 gonarthritis suffering from knee pain, with a VAS score ≥5 for >6 months. METHODS Eligible participants were randomly assigned to receive either CNARF or PNMRF of the superior medial, superior lateral, and inferior medial genicular nerves. The VAS and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before and at 1, 6, and 12 months after treatment. Medication use was quantified before and at 6 months after the intervention. Potential characteristics associated with the efficacy of radiofrequency intervention were explored by using multivariable statistical models. RESULTS A total of 188 participants were included. The magnitude and duration of beneficial effect and reduction in analgesic use were significantly greater in the CNARF group. Success at 6 months after radiofrequency treatment decreased with grade 4 gonarthritis; higher pre-interventional VAS score; and concomitant depression, anxiety disorder, and diabetes mellitus. CONCLUSIONS Therapeutic efficacy and reduction in analgesic consumption were superior after CNARF. Treatment success at 6 months after radiofrequency intervention decreased with more severe gonarthritis; higher pre-interventional pain intensity; and concomitant depression, anxiety disorder, and diabetes mellitus.
Collapse
Affiliation(s)
- María M Santana-Pineda
- Department of Anesthesiology and Pain Medicine, University Hospital Campus Jerez de la Frontera, University of Cadíz, Cadíz, Spain
| | - Luc E Vanlinthout
- Department of Anesthesiology and Pain Medicine, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.,Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Universities of Leuven and Hasselt, Leuven and Diepenbeek, Belgium
| | - Samuel Santana-Ramírez
- Department of Orthopedics and Traumatology, University Hospital Campus Jerez de la Frontera, University of Cadíz, Cadíz, Spain
| | - Thibaut Vanneste
- Multidisciplinary Pain Centre at the Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.,Multidisciplinary Pain Centre at the Ziekenhuis Oost-Limburg , Genk, Belgium
| | | |
Collapse
|
12
|
Iijima H, Inoue M, Suzuki Y, Shimoura K, Aoyama T, Madoba K, Takahashi M. Contralateral Limb Effect on Gait Asymmetry and Ipsilateral Pain in a Patient with Knee Osteoarthritis: A Proof-of-Concept Case Report. JBJS Case Connect 2021; 10:e0418. [PMID: 32044778 DOI: 10.2106/jbjs.cc.19.00418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 77-year-old woman with knee osteoarthritis (OA) complained of right (ipsilateral) knee pain for more than 5 years with gait asymmetry. The OA and quadriceps muscle weakness were more severe in the left (contralateral) knee, but she had no pain. Bracing of the left knee led to decreased gait asymmetry, as determined with an inertial measurement unit, and reduced pain in the right knee. CONCLUSION This case highlights the contralateral knee effect on ipsilateral chronic knee pain, possibly through gait asymmetry. These findings provide a mechanistic insight into knee OA-related pain in patients with gait asymmetry and suggest a new rehabilitative approach.
Collapse
Affiliation(s)
- Hirotaka Iijima
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan.,Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Mami Inoue
- Department of Rehabilitation, Kyoto Hakuaikai Hospital, Kyoto, Japan
| | - Yusuke Suzuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuyuki Madoba
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, Chiba, Japan
| | - Masaki Takahashi
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan
| |
Collapse
|
13
|
Gao ZX, Long NJ, Zhang SY, Yu W, Dai YX, Xiao C. Comparison of Kinematic Alignment and Mechanical Alignment in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Clinical Trials. Orthop Surg 2020; 12:1567-1578. [PMID: 33099892 PMCID: PMC7767667 DOI: 10.1111/os.12826] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/31/2020] [Accepted: 09/16/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to estimate whether kinematic alignment (KA) improves knee function or clinical outcomes compared with mechanical alignment (MA) in the short term after total knee arthroplasty (TKA). We searched the literature for randomized controlled trials published before January 2020 from PubMed, EMBASE, Google, Web of Science, Cochrane Library, and other databases. The observation markers included "The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index," "Knee Society Score (KSS)," "Oxford Knee Score (OKS)," "combined Knee Society Score (KSS)," "Knee injury and Osteoarthritis Outcome Score (KOOS)," "European Quality of Life Measure-5 Domain-5-Level (EQ-5D-5L)," range of motion (ROM), lower limb alignment, ligament release, and complications. A total of 11 randomized controlled trial studies were included in the study. During the follow-up of 6-24 months, the KA-TKA group was superior to the MA-TKA group in terms of WOMAC scores, combined KSS, KSS, knee function scores, and knee range of flexion, but there was no significant difference in EQ-5D-5L, KOOS, KOOS (symptoms, pain, ADL, sports, and quality of life), complications, knee range of extension, hip-knee-ankle (HKA) angle, tibial component slope angle, lateral distal femoral angle (LDFA) or medial proximal tibial angle (MPTA) angle between the MA-TKA group and the MA-TKA group (P > 0.05). Our meta-analysis revealed that the incidence of ligament release in the MA-TKA group was higher than that in the KA-TKA group. This meta-analysis shows that the KA-TKA group had better clinical outcomes and knee range of flexion than the MA-TKA group at short-term follow-up.
Collapse
Affiliation(s)
- Zhi-Xiang Gao
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Neng-Ji Long
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Shao-Yun Zhang
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Wei Yu
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Yi-Xin Dai
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Cong Xiao
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| |
Collapse
|
14
|
Roelofsen EGJ, van Cingel R, Pronk Y, Staal JB, Nijhuis-van der Sanden MWG, Meulenbroek RGJ. Leg-amplitude differentiation guided by haptic and visual feedback to detect alterations in motor flexibility due to Total Knee Replacement. Hum Mov Sci 2020; 71:102623. [PMID: 32452440 DOI: 10.1016/j.humov.2020.102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Following total knee replacement (TKR), patients often persist in maladaptive motor behavior which they developed before surgery to cope with symptoms of osteoarthritis. An important challenge in physical therapy is to detect, recognize and change such undesired movement behavior. The goal of this study was to measure the differences in clinical status of patients pre-TKR and post-TKR and to investigate if differences in clinical status were accompanied by differences in the patients'' motor flexibility. Eleven TKR participants were measured twice: pre-TKR and post-TKR (twenty weeks after TKR). In order to infer maladaptation, the pre-TKR and post-TKR measurements of the patient group were separately compared to one measurement in a control group of fourteen healthy individuals. Clinical status was measured with the Visual Analogue Scale (VAS) for pain and knee stiffness and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Furthermore, Lower-limb motor flexibility was assessed by means of a treadmill walking task and a leg-amplitude differentiation task (LAD-task) supported by haptic or visual feedback. Motor flexibility was measured by coordination variability (standard deviation (SD) of relative phase between the legs) and temporal variability (sample entropy) of both leg movements. In the TKR-group, the VAS-pain and VAS- stiffness and the subscales of the KOOS significantly decreased after TKR. In treadmill walking, lower-limb motor flexibility did not significantly change after TKR. Between-leg coordination variability was significantly lower post-TKR compared to controls. In the LAD-task, a significant decrease of between-leg coordination variability between pre-TKR and post-TKR was accompanied by a significant increase in temporal variability. Post-TKR-values of lower-limb flexibility approached the values of the control group. The results demonstrate that a clinically relevant change in clinical status, twenty weeks after TKR, is not accompanied by alterations in lower-limb motor flexibility during treadmill walking but is accompanied by changes in motor flexibility towards the level of healthy controls during a LAD-task with visual and haptic feedback. Challenging patients with non-preferred movements such as amplitude differentiation may be a promising tool in clinical assessment of motor flexibility following TKR.
Collapse
Affiliation(s)
- Eefje G J Roelofsen
- HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research Group, P.O. Box 6960, 6503, GL, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands.
| | - Robert van Cingel
- Sport Medical Center Papendal, Papendallaan 7, 6816, VD, Arnhem, the Netherlands; Radboud University Medical Center, Research Institute for Health Sciences, Scientific Center for Quality of Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Yvette Pronk
- Research Department of Orthopaedic Surgery, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA Mill, the Netherlands
| | - J Bart Staal
- HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research Group, P.O. Box 6960, 6503, GL, Nijmegen, the Netherlands; Radboud University Medical Center, Research Institute for Health Sciences, Scientific Center for Quality of Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Research Institute for Health Sciences, Scientific Center for Quality of Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Ruud G J Meulenbroek
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands
| |
Collapse
|
15
|
Smith SL, Allan R, Marreiros SP, Woodburn J, Steultjens MPM. Muscle Co-Activation Across Activities of Daily Living in Individuals With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 71:651-660. [PMID: 29953745 DOI: 10.1002/acr.23688] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Muscle co-activation has been shown to be elevated in individuals with knee osteoarthritis (OA) during gait. Comparisons of muscle co-activation across different activities of daily living such as stair negotiation have yet to be explored. The aim of this study was to explore muscle co-activation across different activities of daily living in patients with knee OA. METHODS Muscle co-activation was assessed in 77 symptomatic knee OA patients (mean ± SD age 62.5 ± 8.1 years, body mass index 29.4 ± 6.0 kg/m2 , and sex 48:29 female:male) using electromyography (EMG), during a series of walking, stair negotiation (ascent, descent), and sit-to-walk activities. EMG was recorded from 7 sites, mediolateral gastrocnemius, biceps femoris, semitendinosus, vastus lateralis/medialis, and rectus femoris, and normalized to maximal voluntary isometric contraction. Correlation was used to assess the consistency of co-activation across activities. Repeated-measures analysis of variance assessed the muscle combination by activity differences. RESULTS Muscle co-activation was highest during stair ascent. When comparing muscle combinations within the same activity, we found that correlations ranged from r = 0.003 to r = 0.897, of which 80% of the combinations were significant. Between activities, muscle co-activation was significantly different (P < 0.05). Mediolateral muscle co-activation was higher than hamstrings/quadriceps across activities. CONCLUSION Two muscle co-activation strategies were observed during activities of daily living in patients with knee OA to maintain stability. Muscle co-activation was higher during more challenging activities, particularly when the joint was accepting load. Mediolateral muscle co-activation was higher than hamstrings/quadriceps, so that mediolateral co-activation was thought to be a stabilization mechanism, while hamstrings/quadriceps co-activation responds to knee flexion moments, suggesting that different muscle combinations may have different roles in responding to joint demand.
Collapse
Affiliation(s)
- Stephanie L Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Richard Allan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Sara P Marreiros
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Martijn P M Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| |
Collapse
|
16
|
Schlüter DK, Spain L, Quan W, Southworth H, Platt N, Mercer J, Shark LK, Waterton JC, Bowes M, Diggle PJ, Dixon M, Huddleston J, Goodacre J. Use of acoustic emission to identify novel candidate biomarkers for knee osteoarthritis (OA). PLoS One 2019; 14:e0223711. [PMID: 31618217 PMCID: PMC6795455 DOI: 10.1371/journal.pone.0223711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022] Open
Abstract
Our objective was to determine the efficacy and feasibility of a new approach for identifying candidate biomarkers for knee osteoarthritis (OA), based on selecting promising candidates from a range of high-frequency acoustic emission (AE) measurements generated during weight-bearing knee movement. Candidate AE biomarkers identified by this approach could then be validated in larger studies for use in future clinical trials and stratified medicine applications for this common health condition. A population cohort of participants with knee pain and a Kellgren-Lawrence (KL) score between 1-4 were recruited from local NHS primary and secondary care sites. Focusing on participants' self-identified worse knee, and using our established movement protocol, sources of variation in AE measurement and associations of AE markers with other markers were explored. Using this approach we identified 4 initial candidate AE biomarkers, of which "number of hits" showed the best reproducibility, in terms of within-session, day to day, week to week, between-practitioner, and between-machine variation, at 2 different machine upper frequency settings. "Number of hits" was higher in knees with KL scores of 2 than in KL1, and also showed significant associations with pain in the contralateral knee, and with body weight. "Hits" occurred predominantly in 2 of 4 defined movement quadrants. The protocol was feasible and acceptable to all participants and professionals involved. This study demonstrates how AE measurement during simple sit-stand-sit movements can be used to generate novel candidate knee OA biomarkers. AE measurements probably reflect a composite of structural changes and joint loading factors. Refinement of the method and increasing understanding of factors contributing to AE will enable this approach to be used to generate further candidate biomarkers for validation and potential use in clinical trials.
Collapse
Affiliation(s)
- Daniela K. Schlüter
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, England, United Kingdom
- Institute of Population Health Science, Liverpool University, Liverpool, England, United Kingdom
| | - Lucy Spain
- Faculty of Health and Medicine, Lancaster University, Lancaster, England, United Kingdom
- Institute of Science, Natural Resources and Outdoor Studies, University of Cumbria, Carlisle, England, United Kingdom
| | - Wei Quan
- Applied Digital Signal and Image Processing Research Centre, University of Central Lancashire, Preston, England, United Kingdom
| | - Harry Southworth
- Data Clarity Consulting Ltd, Altrincham, England, United Kingdom
| | - Nicola Platt
- Lancaster Health Hub, Lancaster University, Lancaster, England, United Kingdom
| | - Joe Mercer
- The Christie NHS Foundation Trust, Manchester, England, United Kingdom
| | - Lik-Kwan Shark
- Applied Digital Signal and Image Processing Research Centre, University of Central Lancashire, Preston, England, United Kingdom
| | - John C. Waterton
- Centre for Imaging Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, England, United Kingdom
| | - Mike Bowes
- Imorphics Ltd, Manchester, England, United Kingdom
| | - Peter J. Diggle
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, England, United Kingdom
| | - Mandy Dixon
- Lancaster Health Hub, Lancaster University, Lancaster, England, United Kingdom
| | - Jane Huddleston
- Lancaster Health Hub, Lancaster University, Lancaster, England, United Kingdom
| | - John Goodacre
- Faculty of Health and Medicine, Lancaster University, Lancaster, England, United Kingdom
- * E-mail:
| |
Collapse
|
17
|
Iijima H, Shimoura K, Ono T, Aoyama T, Takahashi M. Proximal gait adaptations in individuals with knee osteoarthritis: A systematic review and meta-analysis. J Biomech 2019; 87:127-141. [PMID: 30904334 DOI: 10.1016/j.jbiomech.2019.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Clarifying proximal gait adaptations as a strategy to reduce knee joint loading and pain for individuals with knee osteoarthritis (OA) contributes to understanding the pathogenesis of multi-articular OA changes and musculoskeletal pain in other joints. We aimed to determine whether biomechanical alterations in knee OA patients during level walking is increased upper trunk lean in the frontal and sagittal planes, and subsequent alteration in external hip adduction moment (EHAM) and external hip flexion moment (EHFM). A literature search was conducted in PubMed, PEDro, CINAHL, and Cochrane CENTRAL through May 2018. Where possible, data were combined into a meta-analysis; pooled standardized mean differences (SMD) of between knee OA patients and healthy adults were calculated using a random-effect model. In total, 32 articles (2037 participants, mean age, 63.0 years) met inclusion criteria. Individuals with knee OA had significantly increased lateral trunk lean toward the ipsilateral limb (pooled SMD: 1.18; 95% CI: 0.59, 1.77) along with significantly decreased EHAM. These subjects also displayed a non-significantly increased trunk/pelvic flexion angle and EHFM. The GRADE approach judged all measures as "very low." These results may indicate that biomechanical alterations accompanying knee OA are associated with increased lateral trunk lean and ensuing alterations in EHAM. Biomechanical alterations in the sagittal plane were not evident. Biomechanical adaptations might have negative sequelae, such as secondary hip abductor muscle weakness and low back pain. Thus, investigations of negative sequelae due to proximal gait adaptations are warranted.
Collapse
Affiliation(s)
- Hirotaka Iijima
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan; Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tomoko Ono
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Yokohama, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masaki Takahashi
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan.
| |
Collapse
|
18
|
Gustafson JA, Anderton W, Sowa GA, Piva SR, Farrokhi S. Dynamic knee joint stiffness and contralateral knee joint loading during prolonged walking in patients with unilateral knee osteoarthritis. Gait Posture 2019; 68:44-49. [PMID: 30453143 PMCID: PMC6370490 DOI: 10.1016/j.gaitpost.2018.10.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Long duration walking, a commonly recommended treatment option for knee osteoarthritis (OA), may lead to increased knee joint loading. RESEARCH QUESTION To evaluate the effects of prolonged walking on dynamic knee joint stiffness and contralateral knee joint contact forces (KCFs) in individuals with unilateral symptomatic knee OA. METHODS Twenty-six older adults with knee OA completed a 45-minute bout of walking on a treadmill. Dynamic knee joint stiffness, estimated KCFs, measured ground reaction forces (GRFs), and simulated muscle forces were evaluated for both the symptomatic and asymptomatic limbs at 15-minute intervals using repeated measures, analysis of variance (ANOVA). RESULTS Dynamic knee joint stiffness during the early weight-acceptance phase of gait was significantly higher for the symptomatic limb throughout the 45-minute bout of walking. A significant increase in peak KCFs and simulated muscle forces were also observed during the weight-acceptance phase of gait for both limbs after 30 and 45 min of walking. Additionally, significantly elevated peak KCFs and muscle forces were observed during the late-stance phase of gait for the contralateral asymptomatic limb throughout the 45-minute bout of walking. SIGNIFICANCE Walking durations of 30 min or greater lead to increased knee joint loading. Additionally, the elevated dynamic knee joint stiffness observed for the symptomatic knee during the weight acceptance phase of gait appears to be unrelated to the knee joint loading profile. Finally, the greater KCFs during the late-stance phase of gait observed for the asymptomatic limb are consistent with previously demonstrated risk factors for OA development and progression.
Collapse
Affiliation(s)
- Jonathan A. Gustafson
- Postdoctoral Fellow, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - William Anderton
- Research Engineer, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gwendolyn A. Sowa
- Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara R. Piva
- Associate Professor, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn Farrokhi
- Facility Research Director, DOD-VA Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, CA, USA
| |
Collapse
|
19
|
Biggs PR, Whatling GM, Wilson C, Metcalfe AJ, Holt CA. Which osteoarthritic gait features recover following total knee replacement surgery? PLoS One 2019; 14:e0203417. [PMID: 30682010 PMCID: PMC6347391 DOI: 10.1371/journal.pone.0203417] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022] Open
Abstract
Background Gait analysis can be used to measure variations in joint function in patients with knee osteoarthritis (OA), and is useful when observing longitudinal biomechanical changes following Total Knee Replacement (TKR) surgery. The Cardiff Classifier is an objective classification tool applied previously to examine the extent of biomechanical recovery following TKR. In this study, it is further developed to reveal the salient features that contribute to recovery towards healthy function. Methods Gait analysis was performed on 30 patients before and after TKR surgery, and 30 healthy controls. Median TKR follow-up time was 13 months. The combined application of principal component analysis (PCA) and the Cardiff Classifier defined 18 biomechanical features that discriminated OA from healthy gait. Statistical analysis tested whether these features were affected by TKR surgery and, if so, whether they recovered to values found for the controls. Results The Cardiff Classifier successfully discriminated between OA and healthy gait in all 60 cases. Of the 18 discriminatory features, only six (33%) were significantly affected by surgery, including features in all three planes of the ground reaction force (p<0.001), ankle dorsiflexion moment (p<0.001), hip adduction moment (p = 0.003), and transverse hip angle (p = 0.007). All but two (89%) of these features remained significantly different to those of the control group after surgery. Conclusions This approach was able to discriminate gait biomechanics associated with knee OA. The ground reaction force provided the strongest discriminatory features. Despite increased gait velocity and improvements in self-reported pain and function, which would normally be clinical indicators of recovery, the majority of features were not affected by TKR surgery. This TKR cohort retained pre-operative gait patterns; reduced sagittal hip and knee moments, decreased knee flexion, increased hip flexion, and reduced hip adduction. The changes that were associated with surgery were predominantly found at the ankle and hip, rather than at the knee.
Collapse
Affiliation(s)
- Paul Robert Biggs
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Gemma Marie Whatling
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
| | - Chris Wilson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- University Hospital of Wales, Cardiff, United Kingdom
| | - Andrew John Metcalfe
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Cathy Avril Holt
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
20
|
Waugh N, Mistry H, Metcalfe A, Loveman E, Colquitt J, Royle P, Smith NA, Spalding T. Meniscal allograft transplantation after meniscectomy: clinical effectiveness and cost-effectiveness. Knee Surg Sports Traumatol Arthrosc 2019; 27:1825-1839. [PMID: 30982109 PMCID: PMC6541576 DOI: 10.1007/s00167-019-05504-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/02/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE To assess the clinical effectiveness and cost-effectiveness of meniscal allograft transplantation (MAT) after meniscal injury and subsequent meniscectomy. METHODS Systematic review of clinical effectiveness and cost-effectiveness analysis. RESULTS There is considerable evidence from observational studies, of improvement in symptoms after meniscal allograft transplantation, but we found only one small pilot trial with a randomised comparison with a control group that received non-surgical care. MAT has not yet been proven to be chondroprotective. Cost-effectiveness analysis is not possible due to a lack of data on the effectiveness of MAT compared to non-surgical care. CONCLUSION The benefits of MAT include symptomatic relief and restoration of at least some previous activities, which will be reflected in utility values and hence in quality-adjusted life years, and in the longer term, prevention or delay of osteoarthritis, and avoidance or postponement of some knee replacements, with resulting savings. It is likely to be cost-effective, but this cannot be proven on the basis of present evidence. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Norman Waugh
- Division of Health Sciences, Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK.
| | - Hema Mistry
- 0000 0000 8809 1613grid.7372.1Division of Health Sciences, Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL UK
| | - Andrew Metcalfe
- 0000 0000 8809 1613grid.7372.1Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | | | - Pamela Royle
- 0000 0000 8809 1613grid.7372.1Division of Health Sciences, Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL UK
| | - Nick A. Smith
- 0000 0004 0400 5079grid.412570.5Department of Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Tim Spalding
- 0000 0004 0400 5079grid.412570.5Department of Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| |
Collapse
|
21
|
Jones M, Stanish W, Rutherford D. Co-activation is not altered in the contra-lateral limb of individuals with moderate knee osteoarthritis compared to healthy controls. Clin Biomech (Bristol, Avon) 2018; 59:71-77. [PMID: 30199822 DOI: 10.1016/j.clinbiomech.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/22/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Contra-lateral knee joint function in individuals with moderate knee osteoarthritis is not well understood, despite the functional burden of bilateral osteoarthritis on end stage clinical management. The purpose of this study was to determine whether co-activation and joint biomechanics are altered in the contra-lateral limb compared to age-matched controls. METHODS 20 Individuals with moderate knee osteoarthritis and 20 asymptomatic individuals walked on an instrumented dual belt treadmill at a self-selected speed. Surface electromyography of the knee joint musculature, including quadriceps, hamstrings and gastrocnemius muscles, normalized to maximum voluntary isometric contractions, as well as sagittal plane motion and sagittal and frontal plane moments were collected. Co-contraction indices were calculated and discrete variables from motion and moment data were extracted. Two-sample t-tests and 2-sample mixed model ANOVAs were performed with alpha <0.05. FINDINGS Contra-lateral knee muscle co-activation differences were not found between groups (p > 0.65). Peak knee adduction moment (0.41 Nm/kg vs. 0.32 Nm/kg) and knee adduction moment impulse (0.14 Nm s/kg vs. 0.10 Nm s/kg) were higher in the contra-lateral limb compared to the asymptomatic group respectively, whereas the sagittal motion (9.8° vs. 14.4°) and moment ranges (0.66 Nm/kg vs. 0.86 Nm/kg) during stance were less dynamic (p < 0.03). INTERPRETATION The contra-lateral limb was functioning differently biomechanically despite no changes present in muscle co-activation. Findings suggest biomechanical changes are occurring without greater demand on the neuromuscular system to preserve contra-lateral joint function in moderate knee osteoarthritis gait. A greater focus should be made to address biomechanical abnormalities in both knees of individuals with moderate unilateral symptomatic knee osteoarthritis.
Collapse
Affiliation(s)
- Michelle Jones
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - William Stanish
- Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
| | - Derek Rutherford
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
| |
Collapse
|
22
|
van Tunen JAC, Dell'Isola A, Juhl C, Dekker J, Steultjens M, Thorlund JB, Lund H. Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis - a systematic review and meta-analysis. BMC Musculoskelet Disord 2018; 19:273. [PMID: 30055600 PMCID: PMC6064629 DOI: 10.1186/s12891-018-2202-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/18/2018] [Indexed: 01/28/2023] Open
Abstract
Background To investigate (1) the association of specific biomechanical factors with knee osteoarthritis and knee osteoarthritis development, and (2) the impact of other relevant risk factors on this association. Methods MEDLINE, EMBASE, CINAHL and SPORTDiscus were searched up until April 2017. Studies were included if they fulfilled the following criteria: the study 1) assessed the association of a biomechanical factor with knee osteoarthritis, or knee osteoarthritis development; 2) reported on skeletal malalignment, muscular dysfunction, impaired proprioception, laxity and abnormal loading during gait; 3) was a cohort study with participants developing knee osteoarthritis and participants not developing knee osteoarthritis, or a case-control or cross-sectional study with participants with knee osteoarthritis and without knee osteoarthritis. Risk of bias was assessed with the QUIPS tool and meta-analyses were performed using random effects models. Results Of 6413 unique studies identified, 59 cross-sectional studies were eligible for meta-analyses (9825 participants, 5328 with knee osteoarthritis). No cohort studies fulfilled the inclusion criteria. Compared with healthy controls, patients with knee osteoarthritis have higher odds of having lower muscle strength, proprioception deficits, more medial varus-valgus laxity and less lateral varus-valgus laxity. Patients with medial knee osteoarthritis have higher odds of having a higher knee adduction moment than healthy controls. Level of evidence was graded as ‘very low’ to ‘moderate’ quality. Due to large between study differences moderation of other risk factors on biomechanical risk factors could not be evaluated. Conclusions Patients with knee osteoarthritis are more likely to display a number of biomechanical characteristics. The causal relationship between specific biomechanical factors and the development of knee osteoarthritis could not be determined as no longitudinal studies were included. There is an urgent need for high quality, longitudinal studies to evaluate the impact of specific biomechanical factors on the development of knee osteoarthritis. Trial Registration (PROSPERO ID: CRD42015025092). Electronic supplementary material The online version of this article (10.1186/s12891-018-2202-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joyce A C van Tunen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Andrea Dell'Isola
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.,Department of Rehabilitation, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Joost Dekker
- Department of Rehabilitation Medicine and Department of Psychiatry, EMGO Insitute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Jonas B Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Hans Lund
- Centre for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
23
|
Ro DH, Han HS, Kim SH, Kwak YH, Park JY, Lee MC. Baseline varus deformity is associated with increased joint loading and pain of non-operated knee two years after unilateral total knee arthroplasty. Knee 2018; 25:249-255. [PMID: 29548817 DOI: 10.1016/j.knee.2018.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/01/2018] [Accepted: 01/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goals of this study were (1) to document the gait pattern of patients with unilateral knee osteoarthritis (OA), (2) to determine the knee adduction moment (KAM) changes in the non-operated knee, and (3) to identify the predictors of change in KAM in the non-operated knee. METHODS The study recruited 23 patients with advanced unilateral knee OA. The preoperative Kellgren-Lawrence (KL) grade of the non-operated knee was one or two; non-operated knee pain, rated using a numeric rating scale (NRS), was less than three out of 10 points. We used a commercial gait analysis system to evaluate kinetics and kinematics. Radiological and gait measurements at the two-year follow-up were compared with baseline data. RESULTS The preoperative asymmetrical gait cycle characterized by elongation of the stance phase of the non-operated knee became symmetrical after TKA. The average KAM of the non-operated knee increased (P=0.010) and it was best predicted by the baseline mechanical axis of the non-operated knee. If the baseline mechanical axis was varus four degrees or above (varus group), the average KAM increased by 0.64 (% body weight×height, P=0.015), while for varus less than four degrees (non-varus group), KAM was unchanged. The KL grade was increased in the varus group (P=0.020) but it was unchanged in the non-varus group. Average pain NRS score was also higher (P=0.044) in the varus group. CONCLUSIONS Close follow-up is necessary for patients with a baseline varus deformity of the non-operated knee because of the higher possibility of developing pain, subsequent arthritis and increased joint loading of the non-operated knee. LEVEL OF EVIDENCE III, retrospective cohort study.
Collapse
Affiliation(s)
- Du Hyun Ro
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea
| | | | - Yoon-Ho Kwak
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea
| | - Jae-Young Park
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea
| | - Myung Chul Lee
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea.
| |
Collapse
|
24
|
Metcalfe AJ, Stewart CJ, Postans NJ, Biggs PR, Whatling GM, Holt CA, Roberts AP. Abnormal loading and functional deficits are present in both limbs before and after unilateral knee arthroplasty. Gait Posture 2017; 55:109-115. [PMID: 28437757 PMCID: PMC5450932 DOI: 10.1016/j.gaitpost.2017.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 01/23/2017] [Accepted: 04/03/2017] [Indexed: 02/02/2023]
Abstract
Unilateral knee replacement is often followed by a contralateral replacement in time and the biomechanics of the other knee before and after knee replacement remains poorly understood. The aim of this paper is to distinguish the features of arthritic gait in the affected and unaffected legs relative to a normal population and to assess the objective recovery of gait function post-operatively, with the aim of defining patients at risk of poor post-operative function. Twenty patients with severe knee OA but no pain or deformity in any other lower limb joint were compared to twenty healthy subjects of the same age. Gait analysis was performed and quadriceps and hamstrings co-contraction was measured. Fifteen subjects returned 1year following knee arthroplasty. Moments and impulses were calculated, principal component analysis was used to analyse the waveforms and a classification technique (the Cardiff Classifier) was used to select the most discriminant data and define functional performance. Comparing pre-operative function to healthy function, classification accuracies for the affected and unaffected knees were 95% and 92.5% respectively. Post-operatively, the affected limb returned to the normal half of the classifier in 8 patients, and 7 of those patients returned to normal function in the unaffected limb. Recovery of normal gait could be correctly predicted 13 out of 15 times at the affected knee, and 12 out of 15 times at the unaffected knee based on pre-operative gait function. Focused rehabilitation prior to surgery may be beneficial to optimise outcomes and protect the other joints following knee arthroplasty.
Collapse
Affiliation(s)
- A J Metcalfe
- Warwick Medical School, The University of Warwick, United Kingdom.
| | - C J Stewart
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom; The Institute for Science and Technology in Medicine, Keele University, United Kingdom
| | - N J Postans
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - P R Biggs
- The Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff School of Engineering, Cardiff University, United Kingdom
| | - G M Whatling
- The Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff School of Engineering, Cardiff University, United Kingdom
| | - C A Holt
- The Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff School of Engineering, Cardiff University, United Kingdom
| | - A P Roberts
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| |
Collapse
|
25
|
Muscle co-contraction during gait in individuals with articular cartilage defects in the knee. Gait Posture 2016; 48:68-73. [PMID: 27477711 DOI: 10.1016/j.gaitpost.2016.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/20/2016] [Indexed: 02/02/2023]
Abstract
Increased muscle co-contraction during gait is common in individuals with knee pathology, and worrisome as it is known to amplify tibiofemoral compressive forces. While knees with articular cartilage defects (ACD) are more vulnerable to compressive forces, muscle co-contraction has never been reported in this population. The purpose of this study was to evaluate the extent to which individuals with ACDs in the knee demonstrate elevated quadriceps to hamstrings muscle co-contraction on the involved limb during gait compared to the uninvolved limb and to healthy controls. We also explored the impact of participant characteristics and knee impairments on co-contraction. Twenty-nine individuals with full-thickness knee ACDs (ACD group) and 19 healthy adults (control group) participated in this study. Participants performed five gait trials at self-selected speed, during which activity of the quadriceps and hamstrings muscles were collected with surface electromyography. Three-dimensional motion capture was used to define phases of gait. Quadriceps strength and self-reported outcomes were also assessed in the same session. There were no differences in quadriceps: hamstrings co-contraction between the ACD and control groups, or between the involved and uninvolved limb for the ACD group. For both ACD and control groups, co-contraction was highest in early stance and lowest in late stance. Quadriceps strength was consistently the strongest predictor of muscle co-contraction in both the ACD and the control groups, with individuals with lower strength demonstrating greater co-contraction. Further study is needed to understand the effect of increased muscle co-contraction on joint compressive forces in the presence of varied quadriceps strength.
Collapse
|
26
|
Lewinson RT, Stefanyshyn DJ. Prediction of knee joint moment changes during walking in response to wedged insole interventions. Proc Inst Mech Eng H 2016; 230:335-42. [PMID: 26994119 DOI: 10.1177/0954411916636920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Wedged insoles are prescribed for medial knee osteoarthritis to reduce the knee adduction moment; however, it is currently not possible to predict which patients will in fact experience reduced moments. The purpose of this study was to identify a simple method using two-dimensional data for predicting the expected change in knee adduction moments with wedged insoles. Knee adduction moments during walking were determined for healthy individuals (n = 15) and individuals with medial knee osteoarthritis (n = 19) while wearing their own shoe without an insole (control), with a 6-mm medial wedge and with a 6-mm lateral wedge. The percent changes relative to control were determined. Then, participants completed single-step trials with each footwear condition where only the changes in mediolateral positions of the knee joint center, shank center of mass, ankle joint center, and foot center of mass relative to control were determined. These variables were used as predictors in regression equations where the change in knee adduction moment during walking was the dependent variable. The change in mediolateral positions of the lower extremity during a single step significantly predicted the change in knee adduction moment during walking for the lateral wedge in both the healthy (R(2) = 0.72, p = 0.008) and knee osteoarthritis (R(2) = 0.52, p = 0.026) groups, and also for the medial wedge in both the healthy (R(2) = 0.67, p = 0.016) and knee osteoarthritis (R(2) = 0.54, p = 0.020) groups. The method of using mediolateral position data from a single-step movement to predict walking biomechanics was successful. These data are relatively simple to collect and analyze, offering the possibility for future incorporation into a wedge prediction system.
Collapse
Affiliation(s)
- Ryan T Lewinson
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada Schulich School of Engineering, University of Calgary, Calgary, AB, Canada Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Darren J Stefanyshyn
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
27
|
Joseph G, Hilton J, Jungmann P, Lynch J, Lane NE, Liu F, McCulloch C, Tolstykh I, Link T, Nevitt M. Do persons with asymmetric hip pain or radiographic hip OA have worse pain and structure outcomes in the knee opposite the more affected hip? Data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2016; 24:427-35. [PMID: 26497607 PMCID: PMC4761312 DOI: 10.1016/j.joca.2015.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/18/2015] [Accepted: 10/08/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if asymmetry between hips in pain or radiographic osteoarthritis (RHOA) is associated with worse pain and joint space narrowing (JSN) at baseline and longitudinally in knees contralateral to more affected hips. METHODS We studied 279 participants in the Osteoarthritis Initiative with baseline asymmetry between hips in pain and 483 with asymmetry in RHOA none of whom had a hip replacement for ≥4 years after baseline. RHOA assessed from pelvis radiographs was categorized as none, possible or definite and hip pain on most days of a month in the past year as present/absent. Knee pain (WOMAC scale) and JSN (fixed flexion radiographs) were categorized as none, mild and moderate-severe. We compared knees contralateral and ipsilateral to more affected hips on baseline knee pain and JSN using clustered multinomial regression and on change in knee pain and JSN over 4-5 years using generalized linear and logistic estimating equations. RESULTS Knees contralateral to painful hips had less baseline pain ("moderate-severe" vs "none", relative risk ratio [RRR]: 0.39, 95% CI = 0.27-0.57), but greater baseline JSN ("moderate-severe" vs "none", RRR: 1.62, 95% CI = 1.09-2.38) and greater worsening of pain during follow-up (P = 0.001). Knees contralateral to hips with worse RHOA had nonsignificant trends for greater baseline JSN (P = 0.10) and JSN progression (P = 0.17). CONCLUSION These findings provide limited support for the hypothesis that early asymmetry in hip pain and RHOA is associated with worse pain and structural outcomes in knees contralateral to the more affected hip.
Collapse
Affiliation(s)
- G.B. Joseph
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - J.F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, Mission Hall, 550 16th St. 2nd Floor, Campus Box #0560 San Francisco, CA, 94158
| | - P.M. Jungmann
- Department of Radiology, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany
| | - J.A. Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, Mission Hall, 550 16th St. 2nd Floor, Campus Box #0560 San Francisco, CA, 94158
| | - N. E. Lane
- Department of Internal Medicine, UC Davis Medical Center, Sacramento, CA 95817, USA
| | - F. Liu
- Department of Epidemiology and Biostatistics, University of California San Francisco, Mission Hall, 550 16th St. 2nd Floor, Campus Box #0560 San Francisco, CA, 94158
| | - C.E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, Mission Hall, 550 16th St. 2nd Floor, Campus Box #0560 San Francisco, CA, 94158
| | - I. Tolstykh
- Department of Epidemiology and Biostatistics, University of California San Francisco, Mission Hall, 550 16th St. 2nd Floor, Campus Box #0560 San Francisco, CA, 94158
| | - T.M. Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - M.C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, Mission Hall, 550 16th St. 2nd Floor, Campus Box #0560 San Francisco, CA, 94158
| |
Collapse
|
28
|
Marriott K, Birmingham TB, Kean CO, Hui C, Jenkyn TR, Giffin JR. Five-year changes in gait biomechanics after concomitant high tibial osteotomy and ACL reconstruction in patients with medial knee osteoarthritis. Am J Sports Med 2015; 43:2277-85. [PMID: 26264767 DOI: 10.1177/0363546515591995] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concomitant high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction is a combined surgical procedure intended to improve kinematics and kinetics in the unstable ACL-deficient knee with varus malalignment and medial compartment knee osteoarthritis (OA). PURPOSE To investigate 5-year changes in gait biomechanics as well as radiographic and patient-reported outcomes bilaterally after unilateral, concomitant medial opening wedge HTO and ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS A total of 33 patients (mean ± SD age, 40 ± 9 years) with varus malalignment (mean mechanical axis angle, -5.9° ± 2.9°), medial compartment knee OA, and ACL deficiency completed 3-dimensional gait analysis preoperatively and 2 and 5 years postoperatively. Primary outcomes were the peak external knee adduction (first peak) and flexion moments. Secondary outcomes were the peak external knee extension and transverse plane moments, peak knee angles in all 3 planes, radiographic static knee alignment measures (mechanical axis angle and posterior tibial slope), and the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS There was a substantial decrease in the knee adduction moment in the surgical limb (%BW × H, -1.49; 95% CI, -1.75 to -1.22) and a slight increase in the nonsurgical limb (%BW × H, 0.16; 95% CI, 0.03 to 0.30) from preoperatively to 5 years postoperatively. There was also a decrease in the knee flexion moment for both the surgical (%BW × H, -0.67; 95% CI, -1.19 to -0.15) and nonsurgical limbs (%BW × H, -1.06; 95% CI, -1.49 to -0.64). Secondary outcomes suggested that substantial improvements were maintained at 5 years, although smaller declines were observed in several measures and in both limbs from 2 to 5 years. CONCLUSION Changes in the peak external moments about the knee in all 3 planes during walking were observed 5 years after concomitant medial opening wedge HTO and ACL reconstruction. These findings are consistent with an intended, sustained shift in the mediolateral distribution of knee loads. CLINICAL RELEVANCE These findings suggest that concomitant HTO and ACL reconstruction results in substantial changes in gait biomechanics. Future clinical research comparing treatment strategies is both warranted and required for this relatively uncommon but seemingly biomechanically efficacious procedure.
Collapse
Affiliation(s)
- Kendal Marriott
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Crystal O Kean
- School of Medical and Applied Science, Central Queensland University, Rockhampton, Queensland, Australia
| | - Catherine Hui
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas R Jenkyn
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada Department of Mechanical and Materials Engineering, Faculty of Engineering, University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
29
|
Jungmann PM, Nevitt MC, Baum T, Liebl H, Nardo L, Liu F, Lane NE, McCulloch CE, Link TM. Relationship of unilateral total hip arthroplasty (THA) to contralateral and ipsilateral knee joint degeneration - a longitudinal 3T MRI study from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage 2015; 23:1144-53. [PMID: 25819583 PMCID: PMC4470862 DOI: 10.1016/j.joca.2015.03.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the association of prevalent unilateral total hip arthroplasty (THA) with worsening of degenerative knee abnormalities and clinical outcomes in the ipsilateral and contralateral knee. METHODS Both knees of 30 individuals in the Osteoarthritis Initiative (OAI) with unilateral THA (n = 14 left, n = 16 right) at baseline were assessed at baseline and at 4-year follow-up for Whole-organ MR Imaging Scores (WORMS), cartilage T2 relaxation times (only available for right knees), Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores and upper leg isometric strength. Right knees of 30 individuals without THA were analyzed as controls. Contralateral knees were compared to ipsilateral knees with paired t-tests and to control knees with multivariate regression analysis adjusting for covariates. RESULTS In paired analyses, compared to ipsilateral knees, contralateral knees had higher WORMS total (P = 0.008) and cartilage scores (P = 0.007) at baseline. Over 4 years contralateral knees worsened more on WORMS total score (P = 0.008). Cartilage T2 values were higher in knees contralateral to the THA (baseline, P = 0.02; follow-up, P < 0.001). Contralateral knees had greater declines in knee extension strength (P = 0.04) and had a trend for greater worsening in WOMAC pain, stiffness, function and total scores (P = 0.04-0.09). Similar results were found comparing contralateral knees with control knees in multivariate regression models. CONCLUSIONS Prevalent unilateral THA is associated with an greater progression of degenerative findings for the knee contralateral to THA.
Collapse
Affiliation(s)
- Pia M. Jungmann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA,Department of Radiology, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107, USA
| | - Thomas Baum
- Department of Radiology, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Hans Liebl
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - Lorenzo Nardo
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - Felix Liu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107, USA
| | - Nancy E. Lane
- Department of Internal Medicine, UC Davis Medical Center, Sacramento, CA 95817, USA
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107, USA
| | - Thomas M. Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| |
Collapse
|
30
|
Abstract
Total hip replacement (THR) is a very common procedure undertaken in up to 285 000 Americans each year. Patient satisfaction with THR is very high, with improvements in general health, quality of life, and function while at the same time very cost effective. Although the majority of patients have a high degree of satisfaction with their THR, 27% experience some discomfort, and up to 6% experience severe chronic pain. Although it can be difficult to diagnose the cause of the pain in these patients, this clinical issue should be approached systematically and thoroughly. A detailed history and clinical examination can often provide the correct diagnosis and guide the appropriate selection of investigations, which will then serve to confirm the clinical diagnosis made.
Collapse
Affiliation(s)
- B A Lanting
- London Health Sciences Center, 336 Windermere Ave, London, Ontario, Canada
| | | |
Collapse
|
31
|
Vicente EJD, Rossi BP, Jesus MCPD, Torrejais MM. Descarga de peso e prevalência de degeneração no joelho de indivíduos amputados. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000300013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: Indivíduos amputados apresentam um desequilíbrio na descarga de peso entre os membros inferiores, o que pode desencadear o desenvolvimento da osteoartrite (OA). OBJETIVO: Quantificar a descarga de peso nos membros inferiores de indivíduos protetizados e correlacionar essa descarga com tempo de protetização, idade e com a prevalência de diagnóstico de OA. MATERIAIS E MÉTODOS: Participaram desta pesquisa 12 indivíduos com amputação transtibial ou transfemoral unilateral, com idade entre 19 e 64 anos. Estes foram avaliados por meio de baropodômetro computadorizado, marca IST Informatique®, modelo Foot Work, para quantificar a descarga de peso nos membros inferiores; os participantes também foram submetidos a exame radiográfico do joelho integro, em incidência anteroposterior, para verificar possível degeneração articular e também foram avaliados por um médico reumatologista para associação da possível degeneração com os sinais clínicos. RESULTADOS: O membro intacto dos indivíduos apresentou uma média de descarga de peso de 58,08% (± 5,88) e o membro amputado 41% (± 5,88), apresentando diferença significativa. Dos 12 indivíduos, 25% apresentaram diagnóstico radiográfico de leve degeneração articular no joelho contrário à amputação e nenhum deles teve diagnóstico clínico de OA. Não houve correlação entre idade, tempo de protetização e descarga de peso. Entretanto, indivíduos com maior idade e menor tempo de protetização apresentaram maiores desequilíbrios na descarga de peso. CONCLUSÃO: Amputados de membro inferior apresentam maior sobrecarga articular sobre o membro intacto, sendo que quanto maior a idade em que o indivíduo foi protetizado e menor o tempo de protetização, maior essa sobrecarga. Os que foram protetizados após a terceira década de vida apresentam maior tendência à degeneração articular do joelho intacto.
Collapse
|