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Ulrich B, Erhart-Hledik JC, Asay JL, Omoumi P, Andriacchi TP, Jolles BM, Favre J. Diverse parameters of ambulatory knee moments differ with medial knee osteoarthritis severity and are combinable into a severity index. Front Bioeng Biotechnol 2023; 11:1176471. [PMID: 37383522 PMCID: PMC10293674 DOI: 10.3389/fbioe.2023.1176471] [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: 02/28/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
Objective: To characterize ambulatory knee moments with respect to medial knee osteoarthritis (OA) severity comprehensively and to assess the possibility of developing a severity index combining knee moment parameters. Methods: Nine parameters (peak amplitudes) commonly used to quantify three-dimensional knee moments during walking were analyzed for 98 individuals (58.7 ± 9.2 years old, 1.69 ± 0.09 m, 76.9 ± 14.5 kg, 56% female), corresponding to three medial knee osteoarthritis severity groups: non-osteoarthritis (n = 22), mild osteoarthritis (n = 38) and severe osteoarthritis (n = 38). Multinomial logistic regression was used to create a severity index. Comparison and regression analyses were performed with respect to disease severity. Results: Six of the nine moment parameters differed statistically significantly among severity groups (p ≤ 0.039) and five reported statistically significant correlation with disease severity (0.23 ≤ |r| ≤ 0.59). The proposed severity index was highly reliable (ICC = 0.96) and statistically significantly different between the three groups (p < 0.001) as well as correlated with disease severity (r = 0.70). Conclusion: While medial knee osteoarthritis research has mostly focused on a few knee moment parameters, this study showed that other parameters differ with disease severity. In particular, it shed light on three parameters frequently disregarded in prior works. Another important finding is the possibility of combining the parameters into a severity index, which opens promising perspectives based on a single figure assessing the knee moments in their entirety. Although the proposed index was shown to be reliable and associated with disease severity, further research will be necessary particularly to assess its validity.
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Affiliation(s)
- Baptiste Ulrich
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Jennifer C. Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Jessica L. Asay
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Thomas P. Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Brigitte M. Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne, Switzerland
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Zhao K, Shan C, Luximon Y. Contributions of individual muscle forces to hip, knee, and ankle contact forces during the stance phase of running: a model-based study. Health Inf Sci Syst 2022; 10:11. [PMID: 35719242 PMCID: PMC9203628 DOI: 10.1007/s13755-022-00177-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022] Open
Abstract
Knowledge of muscle forces' contributions to the joint contact forces can assist in the evaluation of muscle function, joint injury prevention, treatment of gait disorders, and arthroplasty planning. This study's objective was to evaluate the contributions of human lower limb muscles to the hip, knee, and ankle joint contact forces during the stance phase of running. A total of 25 muscles (or groups) were investigated based on the OpenSim framework along the anterior-posterior, superoinferior, and mediolateral components of each joint coordinate system. It was revealed that, during the running stance phase, the gluteus medius, gluteus maximus, and iliopsoas mainly contributed to the hip contact force. The soleus, vastus group, and rectus femoris primarily contributed to the knee contact force, while the peroneus, soleus, gluteus medius, and gastrocnemius mainly contributed to the ankle joint force; some muscles simultaneously offloaded the joints during the stance phase. The distributive pattern of the individual muscle functions contributing to the joint load may substantially differ during the running and walking stance phases. This study's findings may further provide suggestive information for the design of lower limb joint prosthesis, the study of the biomechanics of pathologic walking and running, and the progression of joint osteoarthritis.
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Affiliation(s)
- Kaiwei Zhao
- Guangdong Polytechnic Normal University, Guangzhou, Guangdong China
| | - Chun Shan
- Guangdong Polytechnic Normal University, Guangzhou, Guangdong China
| | - Yan Luximon
- The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Variable Stiffness Shoes for Knee Osteoarthritis: An Evaluation of 3-Dimensional Gait Mechanics and Medial Joint Contact Forces. J Appl Biomech 2022; 38:117-125. [PMID: 35313277 DOI: 10.1123/jab.2021-0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/17/2021] [Accepted: 02/11/2022] [Indexed: 11/18/2022]
Abstract
The study aim was to quantify the impact of a commercially available variable stiffness shoe (VSS) on 3-dimensional ankle, knee, and hip mechanics and estimated knee contact forces compared with a control shoe. Fourteen participants (10 females) with knee osteoarthritis completed gait analysis after providing informed consent. Shoe conditions tested were control shoe (New Balance MW411v2) and VSS (Abeo SMART3400). An OpenSim musculoskeletal model with static optimization was used to estimate knee contact forces. There were no differences in joint kinematics or in the knee adduction or flexion moments (P = .06; P = .2). There were increases in the knee internal and external rotation (P = .02; P = .03) and hip adduction and internal rotation moments for VSS versus control (P = .03; P = .02). The estimated contact forces were not different between shoes (total P = .3, medial P = .1, and lateral P = .8), but contact force changes were correlated with changes in the knee adduction moment (medial r2 = .61; P < .007). High variability in knee flexion moment changes and increases in the internal rotation moment combined with small decreases in the knee adduction moment did not lead to decreases in estimated contact forces. These results suggest that evaluation of VSS using only the knee adduction moment may not adequately capture its impact on osteoarthritis.
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Philpott HT, Carter MM, Birmingham TB, Pinto R, Primeau CA, Giffin JR, Lanting BA, Appleton CT. Synovial tissue perivascular edema is associated with altered gait patterns in patients with knee osteoarthritis. Osteoarthritis Cartilage 2022; 30:42-51. [PMID: 34774789 DOI: 10.1016/j.joca.2021.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore mechanisms of mechanoinflammation, we investigated the association between the presence of knee synovial perivascular edema and gait biomechanics that serve as surrogate measures of knee load in patients with knee osteoarthritis (OA). DESIGN Patients with symptomatic, radiographic knee OA and neutral to varus alignment undergoing total knee arthroplasty or high tibial osteotomy participated in this cross-sectional analysis. All participants underwent 3D gait analysis prior to surgery. Synovial biopsies were obtained during surgery for histopathological assessment. The association between the presence of synovial perivascular edema (predictor) and the external knee moment (outcome) in each orthogonal plane was analyzed using multivariate linear regression and polynomial mixed effects regression models, while adjusting for age, sex, BMI, and gait speed. RESULTS Ninety-two patients with complete gait and histopathological data were included. When fitted over 100% of stance, regression models indicated substantial differences between patients with and without synovial perivascular edema for knee moments in frontal, sagittal and transverse planes. The knee adduction moment was higher in patients with edema from 16 to 74% of stance, with the largest difference at 33% of stance (β = 6.87 Nm [95%CI 3.02, 10.72]); whereas the knee flexion-extension moment differed from 15 to 92% of stance, with the largest difference in extension at 60% of stance (β = -10.80 Nm [95%CI -16.20, -5.40]). CONCLUSIONS In patients with knee OA, the presence of synovial perivascular edema identified by histopathology is associated with aberrant patterns of knee loading throughout stance, supporting the link between biomechanics and synovial inflammation.
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Affiliation(s)
- H T Philpott
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - M M Carter
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - T B Birmingham
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - R Pinto
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - C A Primeau
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - J R Giffin
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
| | - B A Lanting
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
| | - C T Appleton
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
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Costello KE, Astephen Wilson JL, Hubley-Kozey CL. Association of Low Physical Activity Levels With Gait Patterns Considered at Risk for Clinical Knee Osteoarthritis Progression. ACR Open Rheumatol 2021; 3:753-763. [PMID: 34687176 PMCID: PMC8593810 DOI: 10.1002/acr2.11319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Although gait analysis provides an estimate of joint loading magnitude and patterns during a typical step, accelerometry provides information about loading frequency. Understanding the relationships between these components of loading and knee osteoarthritis (OA) progression may improve conservative management, as gait interventions may need to account for physical activity levels or vice versa. The primary objective was to examine relationships between gait patterns that have previously been associated with OA progression and accelerometer‐derived metrics of loading frequency. The secondary objective examined the association of accelerometer‐derived metrics and total knee arthroplasty (TKA) at a mean follow‐up of 3.5 years. Methods Fifty‐seven individuals with knee OA underwent gait analysis and 1 week of accelerometer wear. Spearman correlations were calculated between accelerometer‐derived metrics and gait patterns. Differences across quartiles of step count were examined with Jonckheere‐Terpstra tests. In a subsample, baseline differences between TKA and no TKA groups were examined with Mann‐Whitney U‐tests. Results Gait variables previously related to progression were correlated to both step count and moderate‐ to vigorous‐intensity, but not lower‐intensity, physical activity. Individuals in the lowest quartile (~4000 steps/day) exhibited gait patterns previously related to progression. There were no differences in any baseline accelerometer‐derived metrics between those that did and did not undergo TKA at follow‐up. Conclusion Complex relationships exist between gait, physical activity, and OA progression. Accelerometer‐derived metrics may contribute unique information about overall loading for individuals above a certain activity threshold, but for those with lower activity levels, gait may be sufficient to predict clinical progression risk, at least over the short term.
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Affiliation(s)
- Kerry E Costello
- Dalhousie University, Halifax, Nova Scotia, Canada, Boston University, Boston, Massachusetts
| | - Janie L Astephen Wilson
- Dalhousie University, Halifax, Nova Scotia, Canada, and McMaster University, Hamilton, Ontario, Canada
| | - Cheryl L Hubley-Kozey
- Dalhousie University, Halifax, Nova Scotia, Canada, and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Hatfield GL, Costello KE, Astephen Wilson JL, Stanish WD, Hubley-Kozey CL. Association Between Knee Joint Muscle Activation and Knee Joint Moment Patterns During Walking in Moderate Medial Compartment Knee Osteoarthritis: Implications for Secondary Prevention. Arch Phys Med Rehabil 2021; 102:1910-1917. [PMID: 33965394 DOI: 10.1016/j.apmr.2021.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine associations between knee moment features linked to osteoarthritis (OA) progression, gait muscle activation patterns, and strength. DESIGN Cross-sectional secondary analysis. SETTING Gait laboratory. PARTICIPANTS Convenience sample of 54 patients with moderate, medial knee OA (N=54). INTERVENTIONS None. MAIN OUTCOME MEASURES Knee moments and quadriceps and hamstrings activation were examined during walking. Knee extensor and flexor strength were measured. Waveform patterns were extracted using principal component analysis. Each measured waveform was scored against principal components (PCs) that captured overall magnitude (PC1) and early to midstance difference (PC2) features, with higher PC2 scores interpreted as greater moment differential and more prolonged muscle activity. Correlations were calculated between moment PC scores and muscle PC and strength scores. Regression analyses determined moment PC score variance explained by muscle PC scores and strength. RESULTS All correlations for knee adduction moment difference feature (KAMPC2) and prolonged muscle activity (PC2) were significant (r=-0.40 to -0.54). Knee flexion moment difference feature (KFMPC2) was significantly correlated with all quadriceps and medial hamstrings PC2 scores (r=-0.47 to -0.61) and medial hamstrings magnitude feature (PC1) (r=-0.52). KAMPC2 was significantly correlated with knee flexor strength (r=0.43), and KFMPC2 was significantly correlated with knee extensor (r=0.60) and flexor (r=0.55) strength. Regression models including muscle PC2 scores and knee flexor strength explained 46% of KAMPC2 variance, whereas muscle PC2 scores and knee extensor strength explained 59% of KFMPC2 variance. CONCLUSIONS Muscle activation patterns and strength explained significant variance in moment difference features, highest for the knee flexion moment. This supports that exercises such as neuromuscular training, focused on appropriate muscle activation patterns, and strengthening have the potential to alter dynamic loading gait patterns associated with knee OA clinical progression.
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Affiliation(s)
- Gillian L Hatfield
- School of Kinesiology, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Kerry E Costello
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA; Section of Rheumatology, Boston University School of Medicine, Boston, MA
| | - Janie L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - William D Stanish
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl L Hubley-Kozey
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Affiliated Scientist Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
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Goślińska J, Wareńczak A, Miedzyblocki M, Hejdysz K, Adamczyk E, Sip P, Chlebuś E, Gośliński J, Owczarek P, Woźniak A, Lisiński P. Wireless Motion Sensors-Useful in Assessing the Effectiveness of Physiotherapeutic Methods Used in Patients with Knee Osteoarthritis-Preliminary Report. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2268. [PMID: 32316331 PMCID: PMC7219042 DOI: 10.3390/s20082268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
Osteoarthritis of the knee (OAK) is characterized by pain, limitation of joint mobility, and significant deterioration of proprioception resulting in functional decline. This study assessed proprioception in OAK patients following two ten-day rehabilitation programs using the Orthyo® system. Fifty-four study participants with clinical symptoms and radiological signs of OAK were randomly divided into an exercise group (n = 27) or a manual therapy group (n = 27). The control group consisted of 27 volunteers with radiological signs of OAK, but with no clinical symptoms or prior history of rehabilitation. The following parameters were assessed: knee proprioception using inertial sensors and a mobile application, patients' function using Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and pain intensity using the visual analog scale (VAS). Following rehabilitation, knee proprioception tests did not improve in either study group. Both study groups showed significant improvement of the WOMAC-assessed function (exercise group: p < 0.01, manual therapy group: p = 0.01) and a significant decrease (p < 0.01) of VAS-assessed pain following rehabilitation, but the post-therapy results did not differ significantly between the aforementioned groups. The Orthyo® system provided a quick and accurate assessment of the knee joint position sense. There was no direct relationship between functionality, pain, and proprioception threshold in the knee joint.
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Affiliation(s)
- Jagoda Goślińska
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland; (A.W.); (M.M.); (K.H.); (E.A.); (P.S.); (E.C.); (P.L.)
| | - Agnieszka Wareńczak
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland; (A.W.); (M.M.); (K.H.); (E.A.); (P.S.); (E.C.); (P.L.)
| | - Margaret Miedzyblocki
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland; (A.W.); (M.M.); (K.H.); (E.A.); (P.S.); (E.C.); (P.L.)
| | - Krystyna Hejdysz
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland; (A.W.); (M.M.); (K.H.); (E.A.); (P.S.); (E.C.); (P.L.)
| | - Ewa Adamczyk
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland; (A.W.); (M.M.); (K.H.); (E.A.); (P.S.); (E.C.); (P.L.)
| | - Paweł Sip
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland; (A.W.); (M.M.); (K.H.); (E.A.); (P.S.); (E.C.); (P.L.)
| | - Ewa Chlebuś
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland; (A.W.); (M.M.); (K.H.); (E.A.); (P.S.); (E.C.); (P.L.)
| | - Jarosław Gośliński
- Aisens Sp. z o. o., Lubeckiego 23A, 60-348 Poznań, Poland; (J.G.); (P.O.); (A.W.)
| | - Piotr Owczarek
- Aisens Sp. z o. o., Lubeckiego 23A, 60-348 Poznań, Poland; (J.G.); (P.O.); (A.W.)
| | - Adam Woźniak
- Aisens Sp. z o. o., Lubeckiego 23A, 60-348 Poznań, Poland; (J.G.); (P.O.); (A.W.)
| | - Przemysław Lisiński
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland; (A.W.); (M.M.); (K.H.); (E.A.); (P.S.); (E.C.); (P.L.)
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