Differences in Baseline Joint Moments and Muscle Activation Patterns Associated With Knee Osteoarthritis Progression When Defined Using a Clinical Versus a Structural Outcome

in Journal of Applied Biomechanics
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Both structural and clinical changes can signify knee osteoarthritis progression; however, these changes are not always concurrent. A better understanding of mechanical factors associated with progression and whether they differ for structural versus clinical outcomes could lead to improved conservative management. This study examined baseline gait differences between progression and no progression groups defined at an average of 7-year follow-up using 2 different outcomes indicative of knee osteoarthritis progression: radiographic medial joint space narrowing and total knee arthroplasty. Of 49 individuals with knee osteoarthritis who underwent baseline gait analysis, 32 progressed and 17 did not progress using the radiographic outcome, while 13 progressed and 36 did not progress using the arthroplasty outcome. Key knee moment and electromyography waveform features were extracted using principal component analysis, and confidence intervals were used to examine between-group differences in these metrics. Those who progressed using the arthroplasty outcome had prolonged rectus femoris and lateral hamstrings muscle activation compared with the no arthroplasty group. Those with radiographic progression had greater mid-stance internal knee rotation moments compared with the no radiographic progression group. These results provide preliminary evidence for the role of prolonged muscle activation in total knee arthroplasty, while radiographic changes may be related to loading magnitude.

Costello, Astephen Wilson, Stanish, and Hubley-Kozey are with the School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada. Astephen Wilson, Stanish, and Urquhart are with the Department of Surgery, Dalhousie University, Halifax, NS, Canada. Costello is also with Physical Therapy & Athletic Training, Boston University, Boston, MA, USA; and the Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA. Astephen Wilson is also with the Department of Surgery, McMaster University, Hamilton, ON, Canada. Hubley-Kozey is also with the School of Physiotherapy, Dalhousie University, Halifax, NS, Canada; and an Affiliated Scientist at the Nova Scotia Health Authority, Halifax, NS, Canada.

Costello (kerry.costello@dal.ca) is corresponding author.
  • 1.

    Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:21632196. PubMed ID: 23245607 doi:10.1016/S0140-6736(12)61729-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Bombardier C, Hawker G, Mosher D, on behalf of the Arthritis Alliance of Canada. The Impact of Arthritis in Canada: Today and Over the Next 30 Years. 2011. Available at: http://www.arthritisalliance.ca/en/initiativesen/impact-of-arthritis

    • Search Google Scholar
    • Export Citation
  • 3.

    Pereira D, Peleteiro B, Araujo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage. 2011;19(11):12701285. PubMed ID: 21907813 doi:10.1016/j.joca.2011.08.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137162. PubMed ID: 18279766 doi:10.1016/j.joca.2007.12.013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Reeves ND, Bowling FL. Conservative biomechanical strategies for knee osteoarthritis. Nat Rev Rheumatol. 2011;7(2):113122. PubMed ID: 21289615 doi:10.1038/nrrheum.2010.212

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. 2002;61(7):617622. PubMed ID: 12079903 doi:10.1136/ard.61.7.617

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Bennell KL, Bowles KA, Wang Y, Cicuttini F, Davies-Tuck M, Hinman RS. Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis. Ann Rheum Dis. 2011;70(10):17701774. PubMed ID: 21742637 doi:10.1136/ard.2010.147082

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Chehab EF, Favre J, Erhart-Hledik JC, Andriacchi TP. Baseline knee adduction and flexion moments during walking are both associated with 5 year cartilage changes in patients with medial knee osteoarthritis. Osteoarthritis Cartilage. 2014;22(11):18331839. PubMed ID: 25211281 doi:10.1016/j.joca.2014.08.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Chang AH, Moisio KC, Chmiel JS, et al. External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis. Osteoarthritis Cartilage. 2015;23(7):10991106. PubMed ID: 25677110 doi:10.1016/j.joca.2015.02.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Brisson NM, Wiebenga EG, Stratford PW, et al. Baseline knee adduction moment interacts with body mass index to predict loss of medial tibial cartilage volume over 2.5 years in knee Osteoarthritis. J Orthop Res. 2017;35(11):24762483. PubMed ID: 28323351 doi:10.1002/jor.23564

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Woollard JD, Gil AB, Sparto P, et al. Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis. J Orthop Sports Phys Ther. 2011;41(10):708722. PubMed ID: 21891881 doi:10.2519/jospt.2011.3633

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Chang A, Hurwitz D, Dunlop D, et al. The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis. Ann Rheum Dis. 2007;66(10):12711275. PubMed ID: 17267516 doi:10.1136/ard.2006.062927

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Hodges PW, van den Hoorn W, Wrigley TV, et al. Increased duration of co-contraction of medial knee muscles is associated with greater progression of knee osteoarthritis. Man Ther. 2016;21:151158. PubMed ID: 26254263 doi:10.1016/j.math.2015.07.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Hatfield GL, Stanish WD, Hubley-Kozey CL. Relationship between knee adduction moment patterns extracted using principal component analysis and discrete measures with different amplitude normalizations: Implications for knee osteoarthritis progression studies. Clin Biomech. 2015;30(10):11461152. doi:10.1016/j.clinbiomech.2015.08.011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Hatfield GL, Stanish WD, Hubley-Kozey CL. Three-dimensional biomechanical gait characteristics at baseline are associated with progression to total knee arthroplasty. Arthritis Care Res (Hoboken). 2015;67(7):10041014. doi:10.1002/acr.22564

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Barker K, Lamb SE, Toye F, Jackson S, Barrington S. Association between radiographic joint space narrowing, function, pain and muscle power in severe osteoarthritis of the knee. Clin Rehabil. 2004;18(7):793800. PubMed ID: 15573836 doi:10.1191/0269215504cr754oa

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Coxon D, Frisher M, Jinks C, Jordan K, Paskins Z, Peat G. The relative importance of perceived doctor’s attitude on the decision to consult for symptomatic osteoarthritis: a choice-based conjoint analysis study. BMJ Open. 2015;5(10):e009625. PubMed ID: 26503396 doi:10.1136/bmjopen-2015-009625

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Zhang Y, Niu J. Editorial: shifting gears in osteoarthritis research toward symptomatic osteoarthritis. Arthritis Rheumatol. 2016;68(8):17971800. PubMed ID: 27058963 doi:10.1002/art.39704

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Gendreau M, Hufford MR, Stone AA. Measuring clinical pain in chronic widespread pain: selected methodological issues. Best Pract Res Clin Rheumatol. 2003;17(4):575592. PubMed ID: 12849713 doi:10.1016/S1521-6942(03)00031-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Hunter DJ, McDougall JJ, Keefe FJ. The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am. 2008;34(3):623643. PubMed ID: 18687276 doi:10.1016/j.rdc.2008.05.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Gossec L, Paternotte S, Bingham CO 3rd, et al. OARSI/OMERACT initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis. An OMERACT 10 Special Interest Group. J Rheumatol. 2011;38(8):17651769. PubMed ID: 21807799 doi:10.3899/jrheum.110403

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Escobar A, Quintana JM, Arostegui I, et al. Development of explicit criteria for total knee replacement. Int J Technol Assess Health Care. 2003;19(1):5770. PubMed ID: 12701939 doi:10.1017/S0266462303000060

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Hubley-Kozey CL, Hatfield G, Stanish WD. Muscle activation differences during walking between those with moderate knee osteoarthritis who progress to total knee arthroplasty and those that do not: a follow up study. Paper presented at: World Congress on Osteoarthritis; 2013. Philadelphia, PA.

    • Export Citation
  • 24.

    Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res. 2008;26(3):332341. PubMed ID: 17960658 doi:10.1002/jor.20496

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ, Hubley-Kozey CL. Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels. J Biomech. 2008;41(4):868876. PubMed ID: 18078943 doi:10.1016/j.jbiomech.2007.10.016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Davis EM, Hubley-Kozey CL, Landry SC, Ikeda DM, Stanish WD, Astephen Wilson JL. Longitudinal evidence links joint level mechanics and muscle activation patterns to 3-year radiographic progression of knee osteoarthritis. Clin Biomech. 2019;61:233239.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):10391049. PubMed ID: 3741515 doi:10.1002/art.1780290816

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Astephen Wilson JL, Stanish WD, Hubley-Kozey CL. Asymptomatic and symptomatic individuals with the same radiographic evidence of knee osteoarthritis walk with different knee moments and muscle activity. J Orthop Res. 2017;35(8):16611670. PubMed ID: 27775183 doi:10.1002/jor.23465

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Scott WW Jr, Lethbridge-Cejku M, Reichle R, Wigley FM, Tobin JD, Hochberg MC. Reliability of grading scales for individual radiographic features of osteoarthritis of the knee. The Baltimore longitudinal study of aging atlas of knee osteoarthritis. Invest Radiol. 1993;28(6):497501. doi:10.1097/00004424-199306000-00005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Hubley-Kozey CL, Deluzio KJ, Landry SC, McNutt JS, Stanish WD. Neuromuscular alterations during walking in persons with moderate knee osteoarthritis. J Electromyogr Kinesiol. 2006;16(4):365378. PubMed ID: 16213159 doi:10.1016/j.jelekin.2005.07.014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed. J Biomech. 2007;40(8):17541761. PubMed ID: 17084845 doi:10.1016/j.jbiomech.2006.08.010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. 1983;105(2):136144. PubMed ID: 6865355 doi:10.1115/1.3138397

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Challis JH. An examination of procedures for determining body segment attitude and position from noisy biomechanical data. Med Eng Phys. 1995;17(2):8390. PubMed ID: 7735647 doi:10.1016/1350-4533(95)91877-J

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Costigan PA, Wyss UP, Deluzio KJ, Li J. Semiautomatic three-dimensional knee motion assessment system. Med Biol Eng Comput. 1992;30(3):343350. PubMed ID: 1453807 doi:10.1007/BF02446973

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    DeLuzio KJ, Wyss UP, Li J, Costigan PA. A procedure to validate three-dimensional motion assessment systems. J Biomech. 1993;26(6):753759. PubMed ID: 8514818 doi:10.1016/0021-9290(93)90037-F

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Li J, Wyss UP, Costigan PA, Deluzio KJ. An integrated procedure to assess knee-joint kinematics and kinetics during gait using an optoelectric system and standardized X-rays. J Biomed Eng. 1993;15(5):392400. doi:10.1016/0141-5425(93)90076-B

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Vaughan CL, Hay JG, Andrews JG. Closed loop problems in biomechanics. Part II--an optimization approach. J Biomech. 1982;15(3):201210. PubMed ID: 7096374 doi:10.1016/0021-9290(82)90253-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Rutherford DJ, Hubley-Kozey CL, Stanish WD. Maximal voluntary isometric contraction exercises: A methodological investigation in moderate knee osteoarthritis. J Electromyogr Kinesiol. 2011;21(1):154160. PubMed ID: 20926310 doi:10.1016/j.jelekin.2010.09.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Lewek MD, Rudolph KS, Snyder-Mackler L. Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis. J Orthop Res. 2004;22(1):110115. PubMed ID: 14656668 doi:10.1016/S0736-0266(03)00154-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Deluzio KJ, Astephen JL. Biomechanical features of gait waveform data associated with knee osteoarthritis: an application of principal component analysis. Gait Posture. 2007;25(1):8693. PubMed ID: 16567093 doi:10.1016/j.gaitpost.2006.01.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Osborne JW, Costello AB. Sample size and subject to item ratio in principal components analysis. Pract Assess Res Eval (Online). 2004;9(11).

    • Search Google Scholar
    • Export Citation
  • 42.

    Hubley-Kozey CL, Robbins SM, Rutherford DJ, Stanish WD. Reliability of surface electromyographic recordings during walking in individuals with knee osteoarthritis. J Electromyogr Kinesiol. 2013;23(2):334341. PubMed ID: 23352396 doi:10.1016/j.jelekin.2012.12.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Robbins SM, Astephen Wilson JL, Rutherford DJ, Hubley-Kozey CL. Reliability of principal components and discrete parameters of knee angle and moment gait waveforms in individuals with moderate knee osteoarthritis. Gait Posture. 2013;38(3):421427. PubMed ID: 23357757 doi:10.1016/j.gaitpost.2013.01.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Ranstam J. Why the P-value culture is bad and confidence intervals a better alternative. Osteoarthritis Cartilage. 2012;20(8):805808. PubMed ID: 22503814 doi:10.1016/j.joca.2012.04.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol. 2014;10(7):437441. doi:10.1038/nrrheum.2014.44

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27, 372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71(3):262267. PubMed ID: 10919297 doi:10.1080/000164700317411852

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Schipplein OD, Andriacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res. 1991;9(1):113119. PubMed ID: 1984041 doi:10.1002/jor.1100090114

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Bennell KL, Hunt MA, Wrigley TV, Lim BW, Hinman RS. Role of muscle in the genesis and management of knee osteoarthritis. Rheum Dis Clin North Am. 2008;34(3):731754. PubMed ID: 18687280 doi:10.1016/j.rdc.2008.05.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Psek JA, Cafarelli E. Behavior of coactive muscles during fatigue. J Appl Physiol. 1993;74(1):170175. PubMed ID: 8444689 doi:10.1152/jappl.1993.74.1.170

  • 50.

    Astephen Wilson JL, Deluzio KJ, Dunbar MJ, Caldwell GE, Hubley-Kozey CL. The association between knee joint biomechanics and neuromuscular control and moderate knee osteoarthritis radiographic and pain severity. Osteoarthritis Cartilage. 2011;19(2):186193. PubMed ID: 21074628 doi:10.1016/j.joca.2010.10.020

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Hubley-Kozey CL, Hill NA, Rutherford DJ, Dunbar MJ, Stanish WD. Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking. Clin Biomech. 2009;24(5):407414. doi:10.1016/j.clinbiomech.2009.02.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52.

    Lee MS, Trindade MC, Ikenoue T, Schurman DJ, Goodman SB, Smith RL. Effects of shear stress on nitric oxide and matrix protein gene expression in human osteoarthritic chondrocytes in vitro. J Orthop Res. 2002;20(3):556561. PubMed ID: 12038631 doi:10.1016/S0736-0266(01)00149-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Lee MS, Trindade MC, Ikenoue T, Goodman SB, Schurman DJ, Smith RL. Regulation of nitric oxide and bcl-2 expression by shear stress in human osteoarthritic chondrocytes in vitro. J Cell Biochem. 2003;90(1):8086. PubMed ID: 12938158 doi:10.1002/jcb.10611

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Boyer KA. Biomechanical response to osteoarthritis pain treatment may impair long-term efficacy. Exerc Sport Sci Rev. 2018;46(2):121128. PubMed ID: 29346158 doi:10.1249/JES.0000000000000141

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Ramsey DK, Briem K, Axe MJ, Snyder-Mackler L. A mechanical theory for the effectiveness of bracing for medial compartment osteoarthritis of the knee. J Bone Joint Surg Am. 2007;89(11):23982407. PubMed ID: 17974881 doi:10.2106/JBJS.F.01136

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Moyer RF, Birmingham TB, Bryant DM, Giffin JR, Marriott KA, Leitch KM. Valgus bracing for knee osteoarthritis: a meta-analysis of randomized trials. Arthritis Care Res. 2015;67(4):493501. doi:10.1002/acr.22472

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 57.

    Hunter DJ, Altman RD, Cicuttini F, et al. OARSI clinical trials recommendations: knee imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage. 2015;23(5):698715. PubMed ID: 25952343 doi:10.1016/j.joca.2015.03.012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    McKean KA, Landry SC, Hubley-Kozey CL, Dunbar MJ, Stanish WD, Deluzio KJ. Gender differences exist in osteoarthritic gait. Clin Biomech. 2007;22(4):400409. doi:10.1016/j.clinbiomech.2006.11.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59.

    Bederman SS, Rosen CD, Bhatia NN, Kiester PD, Gupta R. Drivers of surgery for the degenerative hip, knee, and spine: a systematic review. Clin Orthop Relat Res. 2012;470(4):10901105. PubMed ID: 21818668 doi:10.1007/s11999-011-2004-x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60.

    Frankel L, Sanmartin C, Hawker G, et al. Perspectives of orthopaedic surgeons on patients’ appropriateness for total joint arthroplasty: a qualitative study. J Eval Clin Pract. 2016;22(2):164170. PubMed ID: 26347053 doi:10.1111/jep.12449

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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