An evaluation of the heel strike transient in obese young adults during walking gait

Investigation of the Associations of Smoking With Hip Osteoarthritis: A Baseline Cross-Sectional and Four- to Five-Year Longitudinal Multicohort Study

OBJECTIVE

This study aimed to investigate the effect of smoking on the prevalence, incidence, and progression of hip osteoarthritis (OA). We used data from the Osteoarthritis Initiative (OAI) and the Cohort Hip and Cohort Knee (CHECK) studies.

METHODS

We analyzed 9,386 hips from 4,716 participants (OAI cohort) and 1,954 hips from 977 participants (CHECK cohort). The primary exposure was smoking status at baseline, categorized as current, former, or never smoker. Outcomes of radiographic hip OA (RHOA) and symptomatic hip OA were evaluated both cross-sectionally at baseline and longitudinally over a 4- to 5-year follow-up, with adjustments for major covariates.

RESULTS

No significant differences were observed between current or former smokers and never smokers for any of the outcomes examined, either at baseline or at the 4- to 5-year follow-up. In the cross-sectional analysis, the odds ratios with 95% confidence intervals for the prevalence of RHOA for current and former smokers were 1.29 (0.68-2.46) and 0.99 (0.70-1.40) in the OAI cohort and 1.38 (0.78-2.44) and 0.85 (0.54-1.32) in the CHECK cohort, respectively. In the longitudinal analysis, odds ratio with 95% confidence intervals for the incidence of RHOA were 1.03 (0.23-4.50) and 0.92 (0.46-1.85) in the OAI cohort and 0.61 (0.34-1.11) and 1.00 (0.69-1.44) in the CHECK cohort, respectively.

CONCLUSION

Our study found no clear association between smoking and the prevalence, incidence, or progression of RHOA or symptomatic hip OA, either at baseline or over a 4- to 5-year period.

Investigation of the association of weight loss with radiographic hip osteoarthritis in older community-dwelling female adults

OBJECTIVE

Most guidelines recommending weight loss for hip osteoarthritis are based on research on knee osteoarthritis. Prior studies found no association between weight loss and hip osteoarthritis, but no previous studies have targeted older adults. Therefore, we aimed to determine whether there is any clear benefit of weight loss for radiographic hip osteoarthritis in older adults because weight loss is associated with health risks in older adults.

METHODS

We used data from white female participants aged ≥65 years from the Study of Osteoporotic Fractures. Our exposure of interest was weight change from baseline to follow-up at 8 years. Our outcomes were the development of radiographic hip osteoarthritis (RHOA) and the progression of RHOA over 8 years. Generalized estimating equations (clustering of 2 hips per participant) were used to investigate the association between exposure and outcomes adjusted for major covariates.

RESULTS

There was a total of 11,018 hips from 5509 participants. There was no associated benefit of weight loss for either of our outcomes. The odds ratios (95% confidence intervals) for the development and progression of RHOA were 0.99 (0.92-1.07) and 0.97 (0.86-1.09) for each 5% weight loss, respectively. The results were consistent in sensitivity analyses where participants were limited to those who reported trying to lose weight and who also had a body mass index in the overweight or obese range.

CONCLUSION

Our findings suggest no associated benefit of weight loss in older female adults in the structure of the hip joint as assessed by radiography.

Association Between Change in Body Mass Index and Knee and Hip Replacements: A Survival Analysis of Seven to Ten Years Using Multicohort Data

OBJECTIVE

To define the association between change in body mass index (BMI) and the risk of knee and hip replacement.

METHODS

We used data from 3 independent cohort studies: the Osteoarthritis Initiative (OAI), the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study, which collected data from adults (45-79 years of age) with or at risk of clinically significant knee osteoarthritis. We conducted Cox proportional hazards regression analysis with clustering of both knees and hips per person to determine the association between change in BMI (our exposure of interest) and the incidence of primary knee and hip replacement over 7-10 years' follow-up. Change in BMI (in kg/m2 ) was calculated between baseline and the last follow-up visit before knee or hip replacement, or for knees and hips that were not replaced, the last follow-up visit.

RESULTS

A total of 16,362 knees from 8,181 participants, and 16,406 hips from 8,203 participants, were eligible for inclusion in our knee and hip analyses, respectively. Change in BMI was positively associated with the risk of knee replacement (adjusted hazard ratio [HRadj ] 1.03 [95% confidence interval (95% CI) 1.00-1.06]) but not hip replacement (HRadj 1.00 [95% CI 0.95-1.04]). The association between change in BMI and knee replacement was independent of participants' BMI category at baseline (i.e., normal, overweight, or obese).

CONCLUSION

Public health strategies incorporating weight loss interventions could reduce the burden of knee but not hip replacement surgery.

Influence of body mass index and anterior cruciate ligament reconstruction on gait biomechanics

Body mass index (BMI) and history of anterior cruciate ligament reconstruction (ACLR) independently influence gait biomechanics and knee osteoarthritis risk, but the interaction between these factors is unclear. The purpose of this study was to compare gait biomechanics between individuals with and without ACLR, and with and without overweight/obesity. We examined 104 individuals divided into four groups: with and without ACLR, and with low or high BMI (n = 26 per group). Three-dimensional gait biomechanics were evaluated at preferred speed. The peak vertical ground reaction force, knee flexion angle and excursion, external knee flexion moment, and external knee adduction moment were extracted for analysis. Gait features were compared between groups using 2 (with and without overweight/obesity) × 2 (with and without ACLR) analysis of variance. Primary findings indicated that those with ACLR and high BMI had a larger external knee adduction moment compared with those with low BMI and with (p = 0.004) and without ACLR (p = 0.005), and compared with those without ACLR and high BMI (p = 0.001). The main effects of ACLR and BMI group were found for the knee flexion moment, and those with ACLR and with high BMI had lower knee flexion moments compared with those without ACLR (p = 0.031) and with low BMI (p = 0.021), respectively. Data suggest that individuals with ACLR and high BMI may benefit from additional intervention targeting the knee adduction moment. Moreover, lower external knee flexion moments in those with high BMI and ACLR were consistent, but high BMI did not exacerbate deficits in the knee flexion moment in those with ACLR. [Correction added on 9 November 2022, after first online publication: In the preceding sentence, for clarity, the words "reductions in the lower" was removed from the initial sentence to read "Moreover, lower external knee flexion moments".].

Body mass index moderates the association between gait kinetics, body composition, and femoral knee cartilage characteristics

This study compared femoral cartilage characteristics between age- and sex-matched individuals with (n = 48, age = 22.8 ± 3.5 years; body mass index [BMI] = 33.1 ± 4.1 kg/m² ) and without obesity (n = 48 age = 22.0 ± 2.6 years; BMI = 21.7 ± 1.7 kg/m² ) and evaluated the associations between body composition, quadriceps function, and gait kinetics with femoral cartilage characteristics. Medial and lateral femoral cartilage thickness, medial:lateral thickness ratio and medial and lateral cartilage echo intensity were measured using ultrasound imaging. Body composition was assessed using air displacement plethysmography. Quadriceps function was assessed via maximal isometric knee extension. Three-dimensional gait biomechanics were recorded to extract peak external knee flexion and adduction moments, and peak loading rate of the vertical ground reaction force. Cartilage outcomes were compared between groups using one-way multivariate analysis of variance. Stepwise moderated regression evaluated the association between body composition, quadriceps function, and gait kinetics with femoral cartilage outcomes in individuals with and without obesity. Medial (75.24 vs 65.84; P < .001, d = 1.02) and lateral (58.81 vs 52.22; P < .001, d = 0.78) femoral cartilage echo intensity were higher in individuals with compared with those without obesity. A higher body fat percentage was associated with higher medial and lateral cartilage echo intensity (ΔR²  = 0.09-0.12) in individuals with obesity. A higher knee adduction moment was associated with a larger medial:lateral thickness ratio (ΔR²  = 0.09) in individuals without obesity. No associations were found between quadriceps function and cartilage outcomes. These findings suggest that high body fat in adults with obesity is associated with cartilage echo intensity. The obese body mass index was also associated with a lack of a positive relationship between cartilage thickness and joint loading during walking.

Statistical prediction of load carriage mode and magnitude from inertial sensor derived gait kinematics

Load carriage induces systematic alterations in gait patterns and pelvic-thoracic coordination. Leveraging this information, the objective of this study was to develop and assess a statistical prediction algorithm that uses body-worn inertial sensor data for classifying load carrying modes and load levels. Nine men participated in an experiment carrying a hand load in four modes: one-handed right and left carry, and two-handed side and anterior carry, each at 50% and 75% of the participant's maximum acceptable weight of carry, and a no-load reference condition. Twelve gait parameters calculated from inertial sensor data for each gait cycle, including gait phase durations, torso and pelvis postural sway, and thoracic-pelvic coordination were used as predictors in a two-stage hierarchical random forest classification model with Bayesian inference. The model correctly classified 96.9% of the carrying modes and 93.1% of the load levels. Coronal thoracic-pelvic coordination and pelvis postural sway were the most relevant predictors although their relative importance differed between carrying mode and load level prediction models. This study presents an algorithmic framework for combining inertial sensing with statistical prediction with potential use for quantifying physical exposures from load carriage.

Body Mass Index and Type 2 Collagen Turnover in Individuals After Anterior Cruciate Ligament Reconstruction

CONTEXT

Individuals with an anterior cruciate ligament reconstruction (ACLR) are at an increased risk of developing posttraumatic osteoarthritis. How osteoarthritis risk factors, such as increased body mass index (BMI), may influence early changes in joint tissue metabolism is unknown.

OBJECTIVE

To determine the association between BMI and type 2 cartilage turnover in individuals with an ACLR.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Forty-five individuals (31 women, 14 men) with unilateral ACLR at least 6 months earlier who were cleared for unrestricted physical activity.

MAIN OUTCOME MEASURE(S)

Body mass index (kg/m²) and type 2 collagen turnover were the primary outcomes. Body mass index was calculated from objectively measured height and mass. Serum was obtained to measure type 2 collagen turnover, quantified as the ratio of degradation (collagen type 2 cleavage product [C2C]) to synthesis (collagen type 2 C-propeptide [CP2]; C2C : CP2). Covariate measures were physical activity level before ACLR (Tegner score) and current level of disability (International Knee Documentation Committee Index score). Associations of primary outcomes were analyzed for the group as a whole and then separately for males and females.

RESULTS

Overall, greater BMI was associated with greater C2C : CP2 (r = 0.32, P = .030). After controlling for covariates (Tegner and International Knee Documentation Committee Index scores), we identified a similar association between BMI and C2C : CP2 (partial r = 0.42, P = .009). Among women, greater BMI was associated with greater C2C : CP2 before (r = 0.47, P = .008) and after (partial r = 0.50, P = .008) controlling for covariates. No such association occurred in men.

CONCLUSIONS

Greater BMI may influence greater type 2 collagen turnover in those with ACLR. Individuals, especially women, who maintain or reduce BMI may be less likely to demonstrate greater type 2 collagen turnover ratios after ACLR.

Reference values of gait using APDM movement monitoring inertial sensor system

Normal gait data reported show variability depending on specific equipment and techniques. Reference values of initial contact angle (ICA) and toe-off angle (TOA) are still lacking. We present a normative gait database of 292 healthy adults using the APDM Movement Monitoring inertial sensor system across a large age span of adulthood. Data were collected as participants completed a walk test for 2 min. Normalization was conducted and two factors were extracted by a factor analysis. Six reference gait variables under each factor were presented and the impacts of age, gender and BMI were evaluated by MANOVA and ANCOVA. ICA and TOA were highly correlated with speed and stride length. ICA was significantly larger in men, whereas larger TOA could be observed in women in all age groups but could not achieve significant difference. Overweight and obese adults walked at significantly lower speed, shorter stride length, reduced cadence and longer gait cycle duration. TOA was smaller in the obese group. However, the differences in ICA were not significant. Reference gait values described herein were valuable for identifying and interpreting gait phenomena using APDM®, contributing to rehabilitation of gait dysfunction.