RADIOLOGICAL ASSESSMENT OF KNEE JOINT WIDTH DIFFERENCES IN OLDER ADULTS WITH SYMPTOMATIC MEDIAL KNEE OSTEOARTHRITIS

Knee osteoarthritis (OA) is a degenerative articular disease. The knee joint space width (JSW) is used for grading the severity of knee OA. However, there is a lack of research on differences in the widths of knee joints between both lower limbs in unilateral OA. The purpose of this research was to examine the radiological difference in the affected knee joint and contralateral knee joint by analyzing unilateral older adults with medial knee OA using both knees’ JSW differences. Twenty-five subjects with unilateral medial knee OA participated. X-ray radiographs were used to assess knee JSW, and the paired [Formula: see text]-test was performed to assess the knee joint gap width between the affected side and the unaffected side in the respective medial and lateral sides. The independent [Formula: see text]-test compared the differences between the lateral and medial knee JSWs on the affected side and unaffected side. The paired [Formula: see text]-test did not show a significant difference in the medial and lateral knee JSW on the affected side compared to the unaffected side ([Formula: see text]; 0.11). Meanwhile, the independent [Formula: see text]-test revealed a significant difference between the affected and unaffected sides ([Formula: see text]). This study showed no significant changes in affected knee JSWs compared to unaffected sides, but the difference between the lateral and medial JSWs was significant between the knees affected and unaffected by OA in the older adults with medial knee OA.

Download Full-text

Lower Limb Muscle Strength and Muscle Mass Are Associated With Incident Symptomatic Knee Osteoarthritis: A Longitudinal Cohort Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.804560 ◽

2021 ◽

Vol 12 ◽

Author(s):

Nicola Veronese ◽

Sinisa Stefanac ◽

Ai Koyanagi ◽

Nasser M. Al-Daghri ◽

Shaun Sabico ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Muscle Mass ◽

Lower Limbs ◽

American People ◽

Knee Oa ◽

Skeletal Mass ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee ◽

Significant Difference

Recent literature suggests that sarcopenia, often represented by low lower limbs muscle mass and strength, can be considered a potential risk factor for knee osteoarthritis (OA), but the available literature is still limited. We therefore aimed to investigate whether sarcopenia is associated with a higher risk of radiographic (ROA) and symptomatic knee OA (SxOA) in a large cohort of North American people in the context of the OA initiative. Sarcopenia at baseline was diagnosed in case of low skeletal muscle mass (i.e., lower skeletal mass index) and poor performance in the chair stands test. The outcomes of interest for this study included ROA (radiographical osteoarthritis) if a knee developed a Kellgren and Lawrence (KL) grade ≥2 at follow-up, and SxOA (symptomatic osteoarthritis) defined as new onset of a combination of painful knee OA. Altogether, 2,492 older participants (mean age: 68.4 years, 61.4% females) were included. At baseline, sarcopenia was present in 6.1% of the population. No significant difference in ROA prevalence was observed between those with and without sarcopenia (p=0.76), whilst people with sarcopenia reported a significant higher prevalence of SxOA (p<0.0001). Using a logistic regression analysis, adjusting for potential confounders at baseline and the diagnosis of sarcopenia during follow-up, sarcopenia was associated with a higher incidence of knee SxOA (odds ratio, OR=2.29; 95%CI [confidence interval]: 1.42-3.71; p=0.001), but not knee ROA (OR=1.48; 95%CI: 0.53-4.10; p=0.45). In conclusion, sarcopenia could be associated with a higher risk of negative knee OA outcomes, in particular symptomatic forms.

Download Full-text

Comparison of Gait Biomechanics in Patients with and without Knee Osteoarthritis during Different Phases of Gait

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.09.005 ◽

2018 ◽

Vol 25 (1) ◽

pp. 11-15 ◽

Cited By ~ 1

Author(s):

Karia Monil ◽

Masjedi Milad ◽

Duffell Lynsey ◽

Kotti Margarita ◽

McGregor Alison

Keyword(s):

Linear Regression ◽

Knee Osteoarthritis ◽

Centre Of Pressure ◽

Medial Knee ◽

Knee Oa ◽

Gait Biomechanics ◽

Significant Difference

Background This study aimed to characterise knee adduction angles (KAA) and knee adduction moments (KAM) and compare this with foot centre of pressure (COP) in volunteers with and without knee osteoarthritis (OA). Methods A total of 108 participants were recruited; 84 had no known pathology, 18 had medial knee OA, and six had lateral knee OA. Linear regression was used to determine correlations between the normalised COP, KAM, and KAA during each phase of gait for all participants. Results The first phase of gait demonstrated significant differences between groups for all measures: KAA in all phases, COP in phases one and two, and KAM in phase one only. Conclusion The largest mechanical changes are seen in the first phase of gait in osteoarthritic patients. Although COP is an easy to measure tool, it is not as sensitive as KAA and did not demonstrate a significant difference between healthy and medial OA patients.

Download Full-text

The Effect of Hip Bracing on Gait in Patients with Medial Knee Osteoarthritis

Arthritis ◽

10.1155/2012/240376 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

David Wallace ◽

Christa Barr

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

External Rotation ◽

Protective Mechanism ◽

Joint Loading ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Knee Oa ◽

Repeated Measures Design ◽

Knee Joint Loading

Objective. Impaired hip motion has been associated with heightened medial knee joint loading in patients with knee osteoarthritis (OA). A hip external rotation strap designed to pull the femur into external rotation and abduction may serve as one protective mechanism. The primary aim of our study is to determine if the strap decreases medial knee joint loading during level walking in people with knee OA. Design. This study is a single-day repeated measures design. Methods. 15 volunteers with medial knee OA underwent motion analysis data collection during two randomly assigned walking conditions: (1) wearing the strap and (2) control (no strap). Primary outcome measures were peak pelvis, hip and knee joint motions, and torques. These outcomes were averaged across five trials for each condition. Results. Hip abduction (), trunk lean towards the stance limb () and pelvic tilt () significantly increased with the strap versus control trials. Knee adduction loading did not significantly change with the strap (). Conclusion. The use of the hip external rotation strap resulted in angular changes at the hip and pelvis which may be beneficial for patients with medial knee osteoarthritis.

Download Full-text

A prospective study of relationship between medial joint pain and mild knee osteoarthritis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182741 ◽

2018 ◽

Vol 4 (4) ◽

pp. 655

Author(s):

Brajesh Dadarya ◽

Ashish Sirsikar ◽

Ashok Vidyarthi

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

Joint Pain ◽

Radiological Investigation ◽

Duration Of Symptoms ◽

Medial Knee ◽

Knee Oa ◽

Important Symptom ◽

A Prospective Study ◽

The Relationship

Background: The relationship between joint pain and osteoarthritis is poorly understood, however, the most common patterns associated with knee osteoarthritis are diffuse or medial joint pain. The objective of the study was to test the sensitivity of medial knee joint pain for the diagnosis of mild knee osteoarthritis, and thence its relationship.Methods: This is a prospective analytical study of 124 patients visiting to our out-patient setup in the year 2017, with complaint of medial knee joint pain, which after thorough clinical examination, were investigated radiologically.Results: In our study of 124 patients, there were 69 female (55.5%) and 55 male (47.5%), with a mean age of 59.3 years. The average duration of symptoms was 3.2 years, and the average VAS for severity of pain was 59.3. The sensitivity of medial knee joint pain for mild OA was thus calculated to be 79.8%.Conclusions: Medial knee joint pain is a very important symptom to raise a suspicion and also to warrant further radiological investigation for the early diagnosis and management of knee OA.

Download Full-text

FRI0382 EFFECTS OF GENICULAR NERVE BLOCK IN PATIENTS WITH KNEE OSTEOARTHRITIS WHO HAVE NEUROPATHIC OR NOCICEPTIVE PAIN

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4628 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 788.2-789

Author(s):

B. Tas ◽

P. Akpinar ◽

I. Aktas ◽

F. Unlu Ozkan ◽

I. B. Kurucu

Keyword(s):

Neuropathic Pain ◽

Knee Osteoarthritis ◽

Nerve Block ◽

Intractable Pain ◽

Ultrasound Guided ◽

Lidocaine Group ◽

Knee Oa ◽

Significant Difference ◽

Genicular Artery ◽

Saline Solutions

Background:Genicular nerve block (GNB) is a safe and effective therapeutic procedure for intractable pain associated with chronic knee osteoarthritis (OA)(1). There is increasing support for the neuropathic component to the knee OA pain. Investigators proposed that targeting treatment to the underlying pain mechanism can improve pain management in knee OA (2). There is a debate on injectable solutions used in nerve blocks (3).Objectives:To investigate the analgesic and functional effects of USG-guided GNB in patients with chronic knee OA (with/without neuropathic pain) and to evaluate the efficacy of the anesthetic and non-anesthetic solutions used.Methods:Ninety patients with chronic knee OA between the ages of 50-80 were divided into two groups with and without neuropathic pain according to painDETECT questionnaire (4). The groups were randomized into three subgroups to either the lidocaine group (n=30) or dextrose group (n=29) or saline solutions (n=31). After the ultrasound-guided GNB, quadriceps isometric strengthening exercises and cryotherapy were recommended to the patients. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne-algofunctional Index were assessed at baseline and at 1 week, 1 and 3 months later after the procedure.Results:Statistically significant improvement was observed in all groups with or without neuropathic pain according to VAS values at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05). Statistically significant improvement was observed in all groups with neuropathic pain according to painDETECT values at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05). There was a statistically significant improvement in the groups without neuropathic pain which received dextrose and saline solutions, according to painDETECT values, but not in the group which received lidocain at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p>0.05). There was a statistically significant improvement in all groups with or without neuropathic pain according to WOMAC and Lequesne total scores at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05).Conclusion:We conclude that in patients with chronic knee OA (with/without neuropathic pain), the use of GNB with USG is an analgesic method which provides short to medium term analgesia and functional recovery and has no serious side effects. The lack of significant difference between the anesthetic and non-anesthetic solutions used in the GNB suggests that this may be a central effect rather than a symptom of peripheral nerve dysfunction. It suggests that injection may have an indirect effect through nociceptive processing and changes in neuroplastic mechanisms in the brain. In addition, we can say that regular exercise program contributes to improved physical function with the decrease in pain.References:[1]Kim DH et al. Ultrasound-guided genicular nerve block for knee osteoarthritis: a double-blind, randomized controlled trial of local anesthetic alone or in combination with corticosteroid. Pain Physician 2018;21:41-51.[2]Thakur M et.al. Osteoarthritis pain: nociceptive or neuropathic?. Nat Rev Rheumatol 2014:10(6):374.[3]Lam SKH et al. Transition from deep regional blocks toward deep nerve hydrodissection in the upper body and torso: method description and results from a retrospective chart review. BioMed Research International Volume 2017;7920438.[4]Hochman JR et al. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011 Jun;19(6):647-54.Fig. 1:Ultrasound- guided identification of GNB target sites. Doppler mode. White arrows indicate genicular arteries.A.Superior medial genicular artery.B.Inferior medial genicular artery.C.Superior lateral genicular artery.Disclosure of Interests:None declared

Download Full-text

Biomechanical Changes in Gait Patterns of Patients with Grade II Medial Gonarthritis

Diagnostics ◽

10.3390/diagnostics11071242 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1242

Author(s):

Dmitry Skvortsov ◽

Sergey Kaurkin ◽

Alexey Prizov ◽

Aljona Altukhova ◽

Alexander Troitskiy ◽

...

Keyword(s):

Inertial Sensor ◽

Varus Deformity ◽

Functional Condition ◽

Lower Limbs ◽

Knee Oa ◽

Affected Side ◽

Hip Function ◽

Healthy Control ◽

Grade Ii ◽

Single Support Phase

Deforming osteoarthritis (OA) of the knee is a progressive disease associated with pain and compromised function of the joint. Typical biomechanical modifications in the gait of subjects with medial knee OA are characterized by decreased gait speed and overload on the affected limb. The borderline stage for conservative versus surgical management is Grade II OA. The aim of this research was to study preoperatively the specific features of gait, knee, and hip function in patients with Grade II medial OA. We examined 26 patients with Grade II unilateral gonarthritis with varus deformity and 20 healthy adults. Biomechanical parameters of gait were recorded using an inertial sensor system. The gait cycle (GC) slightly increased both for the affected and for the intact limb. The hip joint movements showed significant symmetrical reduction in the first flexion amplitude, as well as a symmetrical delay in full hip extension at the end of the stance phase. In the knee, the first flexion amplitude was significantly reduced on the affected side compared to healthy control. The extension amplitude in the single support phase was significantly increased in both the affected and the intact lower limbs. The swing amplitude was significantly reduced on the affected side. On the affected side, the changes were more pronounced, both in incidence and in severity. The affected knee showed a syndrome of three reduced amplitudes. In patients, walking is characterized by several groups of symptoms: those of unloading of the affected limb, those of limiting the load on the affected joint and the musculoskeletal system as a whole, and those of gait harmonization. The symptoms of unloading the affected side and those of harmonization are the common symptoms of adaptation, typical for several pathological conditions with a relatively preserved function. The intensity of the observed symptoms can help assess changes in the subject’s functional condition over time and during the treatment.

Download Full-text

Medial knee joint contact force in the intact limb during walking in recently ambulatory service members with unilateral limb loss: a cross-sectional study

PeerJ ◽

10.7717/peerj.2960 ◽

2017 ◽

Vol 5 ◽

pp. e2960 ◽

Cited By ~ 4

Author(s):

Ross H. Miller ◽

Rebecca L. Krupenevich ◽

Alison L. Pruziner ◽

Erik J. Wolf ◽

Barri L. Schnall

Keyword(s):

Knee Joint ◽

Limb Loss ◽

Service Members ◽

Model Parameters ◽

Joint Loading ◽

Cross Sectional ◽

Medial Knee ◽

Knee Oa ◽

Joint Contact ◽

Intact Limb

BackgroundIndividuals with unilateral lower limb amputation have a high risk of developing knee osteoarthritis (OA) in their intact limb as they age. This risk may be related to joint loading experienced earlier in life. We hypothesized that loading during walking would be greater in the intact limb of young US military service members with limb loss than in controls with no limb loss.MethodsCross-sectional instrumented gait analysis at self-selected walking speeds with a limb loss group (N = 10, age 27 ± 5 years, 170 ± 36 days since last surgery) including five service members with transtibial limb loss and five with transfemoral limb loss, all walking independently with their first prosthesis for approximately two months. Controls (N = 10, age 30 ± 4 years) were service members with no overt demographical risk factors for knee OA. 3D inverse dynamics modeling was performed to calculate joint moments and medial knee joint contact forces (JCF) were calculated using a reduction-based musculoskeletal modeling method and expressed relative to body weight (BW).ResultsPeak JCF and maximum JCF loading rate were significantly greater in limb loss (184% BW, 2,469% BW/s) vs. controls (157% BW, 1,985% BW/s), with large effect sizes. Results were robust to probabilistic perturbations to the knee model parameters.DiscussionAssuming these data are reflective of joint loading experienced in daily life, they support a “mechanical overloading” hypothesis for the risk of developing knee OA in the intact limb of limb loss subjects. Examination of the evolution of gait mechanics, joint loading, and joint health over time, as well as interventions to reduce load or strengthen the ability of the joint to withstand loads, is warranted.

Download Full-text

Association of Varus Thrust With Pain and Stiffness and Activities of Daily Living in Patients With Medial Knee Osteoarthritis

Physical Therapy ◽

10.2522/ptj.20140441 ◽

2016 ◽

Vol 96 (2) ◽

pp. 167-175 ◽

Cited By ~ 17

Author(s):

Naoto Fukutani ◽

Hirotaka Iijima ◽

Takahiko Fukumoto ◽

Daisuke Uritani ◽

Eishi Kaneda ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Activities Of Daily Living ◽

Daily Living ◽

Predictor Variable ◽

Cross Sectional Study ◽

Sensitivity Analyses ◽

Varus Alignment ◽

Cross Sectional ◽

Medial Knee ◽

Knee Oa

Background Increasing evidence highlights potential associations between varus thrust and health domains associated with knee osteoarthritis (OA). Objective The aim of this study was to investigate the association between varus thrust and 2 subcategories—“pain and stiffness” and “activities of daily living (ADL)”—of the Japanese Knee Osteoarthritis Measure (JKOM). Design This was a cross-sectional study. Methods In total, 296 outpatients with knee OA visiting orthopedic clinics were enrolled. The inclusion criteria were age ≥50 years, medial knee OA and Kellgren-Lawrence (K/L) grade ≥1 in one or both knees, and the ability to walk independently. Standard posterior-anterior knee radiographs were measured for varus alignment. Participants were video recorded while walking and were evaluated for the presence or absence of varus thrust. Pain and stiffness of the knee joint and ADL were evaluated using the JKOM. Multivariate regressions (outcomes: pain and stiffness and ADL; predictor variable: varus thrust) were performed. Results Varus thrust was present in 46 (16.2%) of 284 patients. Multivariate regression analyses demonstrated that varus thrust is independently associated with pain and stiffness, adjusted for age, sex, body mass index, K/L grade, and varus alignment (β=.17, P=.005). However, the association between varus thrust and ADL was not significant (β=.11, P=.058). Based on sensitivity analyses, including participants of K/L grade 1 had little influence on this analysis. Limitations Only 16.2% of participants had a varus thrust. Moreover, a cause-effect relationship between varus thrust and pain and stiffness remains unknown due to the cross-sectional design of this study. Conclusions Varus thrust was associated with pain and stiffness in patients with medial knee OA. However, the association between varus thrust and ADL did not reach significance.

Download Full-text

A Positive Association Between Foot Posture Index and Medial Compartment Knee Osteoarthritis in Moroccan People

The Open Rheumatology Journal ◽

10.2174/1874312901408010096 ◽

2014 ◽

Vol 8 (1) ◽

pp. 96-99 ◽

Cited By ~ 7

Author(s):

Abourazzak F.E ◽

Kadi N ◽

Azzouzi H ◽

Lazrak F ◽

Najdi A ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Medial Compartment ◽

Control Group ◽

Flat Foot ◽

Pes Cavus ◽

Foot Posture Index ◽

Posture Index ◽

Knee Oa ◽

Significant Difference ◽

Foot Posture

Objectives : To compare foot posture in people with and without medial compartment knee osteoarthritis (OA), and to assess association between its abnormalities and medial compartment knee OA. Methods : We compared the foot posture of patients with clinically and radiographically-confirmed medial compartment knee OA and asymptomatic healthy controls using the foot posture index (FPI), navicular height, and the medial arch. Results : We included 100 patients and 80 asymptomatic controls. The mean age of patients was 59 ± 7 (44-76) years and 48 ± 9 (28-60) years in the control (p=0.06). Patients group have more pronated foot for FPI (1.50 ± 2.68 vs 0.72 ± 2.63; p=0.05), more flat foot (42% vs 22%; p=0.03), and less pes cavus than the control group (58% vs 77%; p=0.004). However, there was no significant difference between the groups in the navicular height (3.90 ± 0.85 cm vs 4.00 ± 0.76 cm; p=0.41). In multivariate statistical analysis, after adjusting for age and body mass index, pronated foot in FPI (OR=1.22, 95%IC= [1.06-1.40], p=0.005), and pes cavus (OR=0.32, 95%IC= [0.11-0.93], p=0.03) had a significant correlation with the knee osteoarthritis. Conclusion : Pronated foot posture and flat foot are significantly associated with medial compartment knee osteoarthritis.

Download Full-text

The Relationship Between Early-Stage Knee Osteoarthritis and Lower-Extremity Alignment, Joint Laxity, and Subjective Scores of Pain, Stiffness, and Function

Journal of Sport Rehabilitation ◽

10.1123/jsr.2014-0170 ◽

2016 ◽

Vol 25 (3) ◽

pp. 213-218

Author(s):

Charlie A. Hicks-Little ◽

Richard D. Peindl ◽

Tricia J. Hubbard-Turner ◽

Mitchell L. Cordova

Keyword(s):

Knee Joint ◽

Lower Extremity ◽

Knee Osteoarthritis ◽

Outcome Measures ◽

Early Stage ◽

Joint Laxity ◽

Knee Oa ◽

Lower Extremity Alignment ◽

Knee Joint Laxity ◽

And Function

Context:Knee osteoarthritis (OA) is a debilitating disease that affects an estimated 27 million Americans. Changes in lowerextremity alignment and joint laxity have been found to redistribute the medial and/or lateral loads at the joint. However, the effect that changes in anteroposterior knee-joint laxity have on lower-extremity alignment and function in individuals with knee OA remains unclear.Objective:To examine anteroposterior knee-joint laxity, lower-extremity alignment, and subjective pain, stiffness, and function scores in individuals with early-stage knee OA and matched controls and to determine if a relationship exists among these measures.Design:Case control.Setting:Sports-medicine research laboratory.Participants:18 participants with knee OA and 18 healthy matched controls.Intervention:Participants completed the Western Ontario McMaster (WOMAC) osteoarthritis questionnaire and were tested for total anteroposterior knee-joint laxity (A-P) and knee-joint alignment (ALIGN).Main Outcome Measures:WOMAC scores, A-P (mm), and ALIGN (°).Results:A significant multivariate main effect for group (Wilks’ Λ = 0.30, F7,26 = 8.58, P < .0001) was found. Knee-OA participants differed in WOMAC scores (P < .0001) but did not differ from healthy controls on ALIGN (P = .49) or total A-P (P = .66). No significant relationships were identified among main outcome measures.Conclusion:These data demonstrate that participants with early-stage knee OA had worse pain, stiffness, and functional outcome scores than the matched controls; however, ALIGN and A-P were no different. There was no association identified among participants’ subjective scores, ALIGN, or A-P measures in this study.

Download Full-text