Effect of a Home Program of Hip Abductor Exercises on Knee Joint Loading, Strength, Function, and Pain in People With Knee Osteoarthritis: A Clinical Trial

BackgroundHip abductor muscle weakness may result in impaired frontal-plane pelvic control during gait, leading to greater medial compartment loading in people with knee osteoarthritis (OA).ObjectiveThis study investigated the effect of an 8-week home strengthening program for the hip abductor muscles on knee joint loading (measured by the external knee adduction moment during gait), strength (force-generating capacity), and function and pain in individuals with medial knee OA.DesignThe study design was a nonequivalent, pretest-posttest, control group design.SettingTesting was conducted in a motor performance laboratory.PatientsAn a priori sample size calculation was performed. Forty participants with knee OA were matched for age and sex with a control group of participants without knee OA.InterventionParticipants with knee OA completed a home hip abductor strengthening program.MeasurementsThree-dimensional gait analysis was performed to obtain peak knee adduction moments in the first 50% of the stance phase. Isokinetic concentric strength of the hip abductor muscles was measured using an isokinetic dynamometer. The Five-Times-Sit-to-Stand Test was used to evaluate functional performance. Knee pain was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire.ResultsFollowing the intervention, the OA group demonstrated significant improvement in hip abductor strength, but not in the knee adduction moment. Functional performance on the sit-to-stand test improved in the OA group compared with the control group. The OA group reported decreased knee pain after the intervention.LimitationsGait strategies that may have affected the knee adduction moment, including lateral trunk lean, were not evaluated in this study.ConclusionsHip abductor strengthening did not reduce knee joint loading but did improve function and reduce pain in a group with medial knee OA.

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It's not all about the knee adduction moment: the role of the knee flexion moment in medial knee joint loading

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2015.03.032 ◽

2015 ◽

Vol 23 (7) ◽

pp. 1038-1040 ◽

Cited By ~ 22

Author(s):

M.W. Creaby

Keyword(s):

Knee Joint ◽

Knee Flexion ◽

Knee Adduction Moment ◽

Joint Loading ◽

Medial Knee ◽

Flexion Moment ◽

Knee Joint Loading

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Timing of Frontal Plane Trunk Lean, Not Magnitude, Mediates Frontal Plane Knee Joint Loading in Patients with Moderate Medial Knee Osteoarthritis

Advances in Orthopedics ◽

10.1155/2018/4526872 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Freyja Hálfdanardóttir ◽

Dan K. Ramsey ◽

Kristín Briem

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

Frontal Plane ◽

Joint Loading ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Hip Abductor ◽

Knee Joint Loading ◽

Abductor Strength ◽

Rate Of Loading

The purpose of this study was to examine the influence of trunk lean and contralateral hip abductor strength on the peak knee adduction moment (KAM) and rate of loading in persons with moderate medial knee osteoarthritis. Thirty-one males (17 with osteoarthritis, 14 controls) underwent 3-dimensional motion analysis, strength testing of hip abductors, and knee range of motion (ROM) measures, as well as completing the knee osteoarthritis outcome score (KOOS). No differences were found between groups or limbs for gait cycle duration, but the osteoarthritis group had longer double-limb support during weight acceptance (p<0.001) and delayed frontal plane trunk motion towards the stance limb (p<0.01). This was reflected by a lower rate of loading for the osteoarthritis group compared to controls (p<0.001), whereas no differences were found for peak KAM. Trunk angle, contralateral hip abductor strength, and BMI explained the rate of loading at the involved knee (p<0.001), an association not found for the contralateral knee or control knees. Prolonged trunk lean over the stance limb may help lower peak KAM values. Rate of frontal plane knee joint loading may partly be mediated by the contralateral limb’s abductor strength, accentuating the importance of bilateral lower limb strength for persons with knee osteoarthritis.

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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.

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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.

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