Article

Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

To determine the relationship between change in body mass and knee-joint moments and forces during walking in overweight and obese older adults with knee osteoarthritis (OA) following an 18-month clinical trial of diet and exercise. Data were obtained from 142 sedentary, overweight, and obese older adults with self-reported disability and radiographic evidence of knee OA who underwent 3-dimensional gait analysis. Gait kinetic outcome variables included peak knee-joint forces and peak internal knee-joint moments. Mixed regression models were created to predict followup kinetic values, using followup body mass as the primary explanatory variable. Baseline body mass was used as a covariate, and thus followup body mass was a surrogate measure for change in body mass (i.e., weight loss). There was a significant direct association between followup body mass and peak followup values of compressive force (P = 0.001), resultant force (P = 0.002), abduction moment (P = 0.03), and medial rotation moment (P = 0.02). A weight reduction of 9.8 N (1 kg) was associated with reductions of 40.6 N and 38.7 N in compressive and resultant forces, respectively. Thus, each weight-loss unit was associated with an approximately 4-unit reduction in knee-joint forces. In addition, a reduction in body weight of 9.8 N (1 kg) was associated with a 1.4% reduction (0.496 Nm) in knee abduction moment. Our results indicate that each pound of weight lost will result in a 4-fold reduction in the load exerted on the knee per step during daily activities. Accumulated over thousands of steps per day, a reduction of this magnitude would appear to be clinically meaningful.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Andra faktorer som också förklarar patologin är biomekaniska orsaker såsom ackumulerad belastning, men det finns också icke mekaniska aspekter (Flugsrud et al., 2010). Fetma är en vanlig komorbiditet hos individer med knä OA och är en väldokumenterad riskfaktor för progression av OA (Tanamas et al., 2013, Sandmark et al., 1999, Messier et al., 2005, Ackerman et al., 2017. ...
... Utifrån biomekaniska förklaringsmodeller är det oklart varför individer med OA i knäleden upplever ökad funktion och minskad smärta vid styrketräning (Bennell et al., 2011, DeVita et al., 2018. Kanske kan en anledning tillskrivas reducerad kroppsvikt (Messier et al., 2005). ...
Thesis
Full-text available
Abstrakt Bakgrund: Osteoartrit (OA) är en ledsjukdom och en av de främsta orsakerna till funktionsnedsättning bland världens befolkning. I rekommendationer för rehabiliteringen ingår bland annat styrketräning. Kliniska erfarenheter visar att programmens innehåll kan sakna principer för progression avseende intensitet, volym och frekvens. Syfte: Syftet med studien var att utföra en systematisk litteraturöversikt och jämföra styrketräningsprogrammens sammansättning hos individer med OA i knäleden enligt utfallsmåtten egenskattad smärta, egenskattad funktion och fysisk funktion. Metod: För datainsamlingen genomfördes sökningarna i databaserna PubMed, SPORTDiscus och Cinahl. Inklusionskriterier var individer med diagnostiserad symptomatisk OA i knäleden där interventionen var styrketräning. Studiedesignen var randomiserade kontrollerade studier där båda könen studerades. Efter urvalsarbete kvarstod 10 artiklar. Resultat: Programmen pågick från 6 till 16 veckor och innefattade utrustning såsom gummiband, fria vikter och styrketräningsmaskiner. Jämfört mot kontrollgruppen visade majoriteten av översiktens interventioner signifikanta förbättringar för The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) och fysisk funktion mellan baseline och slutet av interventionen. Antalet övningar varierade från 1 till 7, intensiteten var både låg och hög och utfördes från 1 till 10 set med 2-15 reps. Alla studier redovisade inte principer för progression. Slutsats: Styrketräning reducerar smärta och tillför ökad funktion hos individer med OA i knäleden. Träningen kan innefatta olika upplägg av motstånd, antal övningar, intensitet, set och reps och kan utföras i hemmiljö eller på gym med handledning av fysioterapeut.
... However, in severe knee OA such as group II, we think this mechanism does not seem to work normally. The phenomenon can be explained by the literatures investigating biomechanical incapability of OA knee [9,19]. Messier et al. [19] suggested that patients with knee OA reduce the knee extension moments and Astephen et al. [9] also reported decreased early stance knee extension moments of progressive OA in biomechanical analysis related with knee OA severity. ...
... The phenomenon can be explained by the literatures investigating biomechanical incapability of OA knee [9,19]. Messier et al. [19] suggested that patients with knee OA reduce the knee extension moments and Astephen et al. [9] also reported decreased early stance knee extension moments of progressive OA in biomechanical analysis related with knee OA severity. On the correlation of knee and LL, Murata et al. [18] reported significantly reduced LL in patients whose limitation of knee extension was more than 5 degrees. ...
Article
Full-text available
Background There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion. Methods We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n = 39]; group II, KLG 3 or 4 [n = 35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to compare the differences of continuous variables. Results In radiographic assessment, TLK (thoracolumbar kyphosis), LL (lumbar lordosis), PT (pelvic tilt), C7 SVA (sagittal vertical axis) in both groups improved significantly after surgery (p < 0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p > 0.05). There were significant differences between the groups at the ultimate follow-up in ODI (− 25.6 vs − 12.1, p < 0.001), SRS total score (%) (28 vs 20, p = 0.037), function subscore (1.4 vs 0.7, p = 0.016), and satisfaction subscore (1.6 vs 0.6, p < 0.001). Conclusion Osteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease. Trial registration This study was retrospectively registered with approval by the institutional review board (IRB) of our institution (approval number: 2018–11-007).
... Obesity defined as global epidemic disease in which Because of overloading on musculoskeletal excessive body fat had accumulated in the adipose tissue; structures, obesity has well-known association with Person of body mass index (BMI) higher than 30 kg/m is orthopedic problems, as any mal-alignment in the body 2 considered as obese. is thought to place undue stress and strain on the It is recognized as serious health problem as its joints, ligaments and muscles which lead to overuse incidence is rapidly increasing at alarming rate [2]. ...
... revealing the film (A Kodak® film). The Q angle is formed 2 Both quadriceps and foot progression angles were by the crossing of two imaginary lines: the first line is measured in both group A and B. ...
... Increased weight has been linked to increased risk and severity of arthritis, although patients often attribute worsening of symptoms to weight gain following reduced activity levels and ability to exercise [3]. Increased weight is multiplied by the effect of joint actions, such that four-fold forces are found acting across joints for every unit increase in weight [4]. ...
... There is however a paucity of data to support the strategy of weight loss or deferring surgery until an optimal BMI is reached. In the knee joint, Messier et al. demonstrated on a mechanical level that forces are increased four-fold with any unit of weight increase [4]. Christensen et al. ...
Article
Full-text available
Background Despite a paucity of evidence, obesity is frequently cited as an exacerbator of symptoms in foot and ankle arthritis. The aims of the current study were to determine whether simulated weight loss would improve symptoms in obese patients with foot and ankle arthritis. Methods Patients walked on an “anti-gravity” treadmill allowing simulated weight reduction. Pain was recorded at baseline weight and then compared with pain at simulated normal BMI. Results Simulated reduction to BMI 25 caused a significant reduction in pain. Mean pain scores improved from baseline to BMI 25 by 32% (15.9 points, p = 0.04). Paired analysis showed a significant improvement in pain scores (p = 0.016) from BMI of 30 to 25. Conclusion Simulated weight loss from high to normal BMI improved arthritic symptoms. This could be used to power future studies to further investigate the effects of weight loss in foot and ankle patients. Level of evidence Level II – repeated measures cohort study.
... However, in severe knee OA such as group II, we think this mechanism does not seem to work normally. The phenomenon can be explained by the literatures investigating biomechanical incapability of OA knee [9,19]. Messier et al [19] suggested that patients with knee OA reduce the knee extension moments and Astephen et al. [9] also reported decreased early stance knee extension moments of progressive OA in biomechanical analysis related with knee OA severity. ...
... The phenomenon can be explained by the literatures investigating biomechanical incapability of OA knee [9,19]. Messier et al [19] suggested that patients with knee OA reduce the knee extension moments and Astephen et al. [9] also reported decreased early stance knee extension moments of progressive OA in biomechanical analysis related with knee OA severity. On the correlation of knee and LL, Murata et al. [18] reported signi cantly reduced LL in patients whose limitation of knee extension was more than 5 degrees. ...
Preprint
Full-text available
Background : There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion. Methods : We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n=39]; group II, KLG 3 or 4 [n=35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to assess the differences of continuous variables. Results : In radiographic assessment, TLK(thoracolumbar kyphosis), LL(lumbar lordosis), PT(pelvic tilt), C7 SVA(sagittal vertical axis) in both groups improved significantly after surgery(p0.05). There were significant differences between the groups at the ultimate follow-up in ODI (-25.6 vs -12.1, p
... Additionally, handlers over the age of 65 had the lowest risk of reporting a severe injury. There was a somewhat elevated risk for middle aged (25-44) aged handlers relative to the youngest category (18)(19)(20)(21)(22)(23)(24). It is possible that younger handlers are choosing faster dogs, and training at a higher intensity in order to keep up with the increased competitiveness and faster course times that have arisen over the last decade. ...
... This correlation has been described in human sports medicine (18), and may be true of canines as well. Increased weight, regardless of the fitness level, places increased stress on an athlete's joints, which could increase injury risk, even in fit animals, as is described in the human literature (19,20). It is unknown why there was a difference between dog weight and injury risk in the North American and non-North American samples, however smaller sample size in the non-North American sample is likely a limitation. ...
Article
Full-text available
Objective The purpose of this study was to compare previously identified demographic risk factors for injury in agility dogs, and explore other potential associations with demographic risk factors in new populations, and across different levels of injury severity. Procedures An internet-based survey of agility handlers was conducted. The primary outcome was if the dog had ever had an injury that kept from agility for over a week. Demographic information about the dog and handler were recorded. Logistic regression was used to quantify associations between variables of interest with injury history and all models were adjusted for age. Analyses were stratified by geographic location. Final model building was done via backward selection. Results The sample included 2,962 dogs from North America and 1,235 dogs from elsewhere. In the North American sample, 8 variables were associated with injury history; dog breed, height and weight, handler age, gender, agility experience, competing at the national level, age dog was acquired, and taking radiographs to assess growth plate closure. In the non-North American sample, 4 variables were associated with injury history; breed, handler age, occupation (dog trainer or not), and handler medical training. In both samples, Border Collies showed a marked increase in injury risk (ORs 1.89 and 2.34) and handler age >65 was associated with lower risk (ORs 0.62 and 0.77). Consistent with previous studies, greater handler experience was associated with reduced risk in the North American sample, but the other sample did not show this pattern, even in unadjusted models. Dog spay/neuter status was not associated with injury risk in either sample. Conclusions and Clinical Relevance Dogs with radiographs assessing growth plate closure may have increased injury risk as this population of owners may plan to train their dog harder, and at an earlier age. This finding also poses the question of whether or not growth plate closure is a good indicator of safety for increasing training intensity. Knowledge of what risk factors exist for injury in agility dogs is imperative in determining direction for future prospective studies, as well as creating recommendations to help prevent injury in this population of dogs.
... However, in severe knee OA such as group II, we think this mechanism does not seem to work normally. The phenomenon can be explained by the literatures investigating biomechanical incapability of OA knee [9,19]. Messier et al [19] suggested that patients with knee OA reduce the knee extension moments and Astephen et al. [9] also reported decreased early stance knee extension moments of progressive OA in biomechanical analysis related with knee OA severity. ...
... The phenomenon can be explained by the literatures investigating biomechanical incapability of OA knee [9,19]. Messier et al [19] suggested that patients with knee OA reduce the knee extension moments and Astephen et al. [9] also reported decreased early stance knee extension moments of progressive OA in biomechanical analysis related with knee OA severity. On the correlation of knee and LL, Murata et al. [18] reported signi cantly reduced LL in patients whose limitation of knee extension was more than 5 degrees. ...
Preprint
Full-text available
Background: There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion. Methods: We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n=39]; group II, KLG 3 or 4 [n=35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to compare the differences of continuous variables. Results: In radiographic assessment, TLK (thoracolumbar kyphosis), LL (lumbar lordosis), PT (pelvic tilt), C7 SVA (sagittal vertical axis) in both groups improved significantly after surgery (p<0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p>0.05). There were significant differences between the groups at the ultimate follow-up in ODI (-25.6 vs -12.1, p<0.001), SRS total score (%) (28 vs 20, p=0.037), function subscore (1.4 vs 0.7, p=0.016), and satisfaction subscore (1.6 vs 0.6, p<0.001). Conclusion: Osteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease. Trial registration: This study was retrospectively registered with approval by the institutional review board(IRB) of our institution(approval number: 2018-11-007).
... Firstly, the tested sample was composed of young adults. Previous research carried out on older adults obese reported that they often exhibit articular problems (such as osteoarthritis) and severe gait alterations [58,59] that could be due to the progressive/cumulative effect of excessive joint loads over the years. Our results, which refer to young adults, could have been influenced by age-factor both in terms of gait pattern and of asymmetry which revealed a moderate severity of gait modifications with respect to controls, confirming that obesity does not determine major and immediate changes in the learned motor strategy in young adult patients. ...
Article
Full-text available
The main purpose of this study is to characterize lower limb joint kinematics during gait in obese individuals by analyzing inter-limb symmetry and angular trends of lower limb joints during walking. To this purpose, 26 obese individuals (mean age 28.5 years) and 26 normal-weight age- and sex-matched were tested using 3D gait analysis. Raw kinematic data were processed to derive joint-specific angle trends and angle-angle diagrams (synchronized cyclograms) which were characterized in terms of area, orientation and trend symmetry parameters. The results show that obese individuals exhibit a kinematic pattern which significantly differs from those of normal weight especially in the stance phase. In terms of inter-limb symmetry, higher values were found in obese individuals for all the considered parameters, even though the statistical significance was detected only in the case of trend symmetry index at ankle joint. The described alterations of gait kinematics in the obese individuals and especially the results on gait asymmetry are important, because the cyclic uneven movement repeated for hours daily can involve asymmetrical spine loading and cause lumbar pain and could be dangerous for overweight individuals.
... A more interesting fact to be furthermore researched in these patients suffering from lower limb OA with knee abnormalities comparable to our results is the importance of BMI in one's OA formation. It is important to underline since it was shown that men that lose weight tend to have a decreased opportunity of developing OA in their elderly years, but not so many findings emphasize which are the differences between the dominant and non-dominant lower limbs [64][65][66]. Females with hip OA (with or without knee OA) present important changes on the dominant limb, even though in literature it has been tried to see whether the dominance of the limb generates OA joint degenerations, or it is actually the disease that may cause differences between limbs, but a longitudinal examination needs approaching as well [67]. ...
Preprint
In time, osteoarthritis (OA) generates the misalignment of the affected joint structures. However, due to the nature of bipedal gait, OA in the lower limb can also cause pathological gait patterns, which can generate instability and falls, with great consequence, especially in the aged population. With goniometry used to evaluate the range of motion of joints (ROM), we wanted to evaluate how gender impacts gait dynamics in OA patients. For this study we have compared 106 OA patients (male=32, female=74) to age matched controls. All participants had their right leg as dominant. Video recording of normal gait was analysed with a digital goniometry tool phone application, and the knee’s ROM was measured in midstance and midswing of the gait. During midstance, significant extension and flexion of the knee excursion have been observed in both males and females. During midswing, knee OA presents more differences, whereas subjects with hip and knee OA present changes on the dominant knee. Midstance changes suggest that the knee’s joint degenerative changes can be linked to hip OA secondary changes. Midswing changes in lower limb OA suggest a connection to the activities of daily life. Gender differences generated by OA must furthermore be studied in both lower limbs so that the best therapeutic approach can be chosen.
... Looking to the future, the impact of gout on the U.S. knee arthroplasty population will likely continue to grow as more medications that induce hyperuricemia are prescribed and obesity rates worsen [1][2][3][4][30][31]. There are clear correlations between increased BMI and both gout and osteoarthritis, therefore heavier patients may be more likely to both have gout and to potentially require a TKA in the future [32][33][34]. While data is limited, prior studies by Teng et al. and Kuo et al. have shown an increased risk for gout patients to progress to TKA at a higher rate than non-gout patients [35][36]. ...
Article
Background Gout is a common synovial pathology, but its prevalence in patients undergoing total knee arthroplasty (TKA) and potential association with complications such as periprosthetic infection (PJI) and revision are unknown. Methods Medicare data from 2009 to 2013 was retrospectively reviewed using PearlDiver. All patients 65 years of age or older and undergoing primary TKA with at least 3 years of pre-TKA records were included. The prevalence of gout was based on ICD-9 codes. Univariable associations of gout with PJI and revision at 1 year were assessed using odds ratios with 95% confidence intrervals (C.I.). To control for potential confounding, patients with a history of gout were matched on age, gender, smoking history, and Elixhauser Comorbidity Index (ECI) to patients without gout and associations reassessed. Results The prevalence of gout in Medicare patients undergoing primary TKA was 5.7%. On univariable analysis, patients with a history of gout were more likely to develop PJI (O.R., 1.58; 95% C.I., 1.45–1.72) and undergo revision (O.R., 1.33; 95% C.I., 1.25–1.41) at 1 year. After matching for confounders, a history of gout was no longer associated with developing PJI (O.R., 0.98; 95% C.I., 0.90–1.06) or undergoing revision (O.R., 0.94; 95% C.I., 0.89–1.00) at 1 year. Conclusions Gout is a relatively common pathology in patients undergoing TKA. While gout is associated with increased complications, this appears to be driven by confounding through its association with other medical comorbidities. Gout does not appear to be an independent risk factor for complications following TKA.
... 25 Weight loss is also associated with a decrease in knee joint forces that is at least equal to, or even up to four times, the absolute weight lost. 26,27 However, overweight, and obese persons may find it difficult to embark on physical activity for weight loss, as they experience pain in their knees on walking. Upon seeking medical attention, they may be prescribed analgesia and advised to avoid aggravating activities. ...
The rate of overweight and obesity is increasing worldwide, with significant health impact. Obesity is a risk factor for morbidity and mortality and weight loss should take a multi-pronged approach, including dietary control and physical activity. The lack of physical activity, sedentary behaviour, as well as poor cardiorespiratory fitness are all independent risk factors for morbidity and mortality as well, thus it is important to advise lifestyle changes to address these issues. Most individuals who have no contraindications can embark on light- to moderate-intensity physical activity without the need for medical clearance. Specific advice on physical activity should be given, targeting the individual, and this can be done using the FITT (frequency, intensity, time, type) principle. Physical activity should also be reviewed regularly and progressed gradually to target physical activity guidelines. Individuals should also be encouraged to replace sedentary behaviour with at least light-intensity physical activity whenever possible.
... Over the last few decades, the number of obese patients needing treatment for endstage knee arthritis has significantly increased. Body weight has been shown as a modifiable risk factor for knee osteoarthritis and disease progression [17][18][19]. In addition, adverse events such as dislocation, aseptic loosening, superficial and deep infection and revision surgery are more common in obese patients undergoing TKA [20][21][22]. ...
Article
Full-text available
Thanks to modern surgical techniques and implants, traditional exclusion criteria for unicompartmental knee arthroplasty (UKA) are no longer considered contraindications. The aim of this study is to clarify the impact of obesity on functional outcomes and revision rates of UKA. We performed a comprehensive systematic review using PubMed–Medline, Google Scholar and Cochrane Central. Then, we extracted data related to body mass index (BMI), age and follow-up, functional outcome scores and rate of revisions (all-cause, aseptic and septic). Patients were stratified according to BMI into two groups: non-obese (BMI < 30) and obese (BMI ≥ 30). We identified 22 eligible studies, of which 13 were included in the meta-analysis. Patients with a BMI > 30 had a significantly higher likelihood for revision (p = 0.02), while the risk of septic revision was similar (p = 0.79). The clinical outcome measures showed a significant difference in favor of patients with a BMI < 30 (p < 0.0001). The improvements in Oxford Knee Score and Knee Society Score were significant in both obese and non-obese patients, although the latter showed inferior results. The results of this systematic review and meta-analysis show that BMI is not a contraindication to UKA. However, obese patients have a higher risk for aseptic failure and lower improvement in clinical scores compared to non-obese patients.
... Moreover, a series of adipose-derived cytokines, such as leptin and adiponectin, were also related to OA [183]. The weight loss strategy can decrease the secretion of these cytokines, suppressing inflammation in OA [184]. Joint realignment and muscle exercise also help to alleviate biomechanical disorders [185,186]. ...
Article
Full-text available
The development of interdisciplinary biomedical engineering brings significant breakthroughs to the field of cartilage regeneration. However, cartilage defects are considerably more complicated in clinical conditions, especially when injuries occur at specific sites (e.g., osteochondral tissue, growth plate, and weight-bearing area) or under inflammatory microenvironments (e.g., osteoarthritis and rheumatoid arthritis). Therapeutic implantations, including advanced scaffolds, developed growth factors, and various cells alone or in combination currently used to treat cartilage lesions, address cartilage regeneration under abnormal conditions. This review summarizes the strategies for cartilage regeneration at particular sites and pathological microenvironment regulation and discusses the challenges and opportunities for clinical transformation.
... 13 Other studies have indicated that joint loading is increased with elevated body mass and estimated that joint loads are reduced as much as 4-fold with each pound of body mass lost. 31 In further support of this hypothesis, Widmyer et al 46 showed that over the course of normal daily activities, participants with high BMI had significantly higher tibial cartilage compressive strains compared with participants with normal BMI. Our results further support the idea that increased joint loading associated with obesity may be a possible factor leading to the initiation of OA, as we demonstrated greater cartilage strains in participants with high BMI. ...
Article
Full-text available
Background: Obesity, which potentially increases loading at the knee, is a common and modifiable risk factor for the development of knee osteoarthritis. The menisci play an important role in distributing joint loads to the underlying cartilage. However, the influence of obesity on the role of the menisci in cartilage load distribution in vivo is currently unknown. Purpose To measure tibial cartilage thickness and compressive strain in response to walking in areas covered and uncovered by the menisci in participants with normal body mass index (BMI) and participants with high BMI. Study Design: Controlled laboratory study. Methods: Magnetic resonance (MR) images of the right knees of participants with normal BMI (<25 kg/m2; n = 8) and participants with high BMI (>30 kg/m2; n = 7) were obtained before and after treadmill walking. The outer margins of the tibia, the medial and lateral cartilage surfaces, and the meniscal footprints were segmented on each MR image to create 3-dimensional models of the joint. Cartilage thickness was measured before and after walking in areas covered and uncovered by the menisci. Cartilage compressive strain was then determined from changes in thickness resulting from the walking task. Results: Before exercise, medial and lateral uncovered cartilage of the tibial plateau was significantly thicker than covered cartilage in both BMI groups. In the uncovered region of the lateral tibial plateau, participants with high BMI had thinner preexercise cartilage than those with a normal BMI. Cartilage compressive strain was significantly greater in medial and lateral cartilage in participants with high BMI compared with those with normal BMI in both the regions covered and those uncovered by the menisci. Conclusion: Participants with high BMI experienced greater cartilage strain in response to walking than participants with normal BMI in both covered and uncovered regions of cartilage, which may indicate that the load-distributing function of the meniscus is not sufficient to moderate the effects of obesity. Clinical Relevance: These findings demonstrate the critical effect of obesity on cartilage function and thickness in regions covered and uncovered by the menisci.
... However, we did not find an association between BMI and KOOS JR scores. While BMI is a known contributor to the development of osteoarthritis, it is also independently associated with the experience of greater pain in osteoarthritic patients and therefore can still be a confounding factor [16][17][18]. ...
Article
Full-text available
PurposeComparing symptoms of patients with focal cartilage defects of the knee to those with knee osteoarthritis.Methods Prospectively maintained databases identified patients with focal cartilage defects (FCD group) who underwent osteochondral allograft transplantation and patients with osteoarthritis (OA group) undergoing arthroplasty. Patients between 18 and 55 years of age were included and matched based on age. Baseline patient demographics, symptoms, and patient-reported outcomes including the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), SF-12, and VR-12 questionnaires were recorded. Patient symptoms and individual responses of the KOOS JR were compared between groups. Regression analysis was used to evaluate the association between pre-operative factors that significantly differed between groups and the KOOS JR questionnaire.ResultsSixty-four patients were included: 32 patients in each group. The FCD group had a significantly lower body mass index (BMI) (p = 0.04) and greater number of workers’ compensation cases (p = 0.027) when compared to the OA group. Patients in the OA group complained more frequently of medial-sided pain (p = 0.02) and knee swelling (p = 0.003). The OA cohort also had greater pain with fully straightening the knee (p = 0.012), pain with standing upright (p = 0.016), and pain with rising from sitting (p = 0.003). Patients in the FCD group had greater KOOS JR outcome scores (51.5 ± 12.9 vs. 41.5 ± 20.5; p = 0.023).Conclusion When compared to patients with focal cartilage defects, adults with knee osteoarthritis scheduled for knee arthroplasty have a more severe presentation of symptoms, particularly medial-sided pain, swelling of the knee, pain associated with straightening the knee, standing upright, and rising from sitting.
... Obesity and its associated metabolic disorders are an important contributor to the progression of OA (1)(2)(3)(4)(5). It is wellaccepted that obesity is mainly caused by an imbalance between energy intake and expenditure that promotes storage of nutrient oversupply in white adipose tissue (6). ...
Article
Full-text available
Obesogenic diets contribute to the pathology of osteoarthritis (OA) by altering systemic and local metabolic inflammation. Yet, it remains unclear how quickly and reproducibly the body responds to weight loss strategies and improve OA. In this study we tested whether switching obese diet to a normal chow diet can mitigate the detrimental effects of inflammatory pathways that contribute to OA pathology. Male C57BL/6 mice were first fed with obesogenic diet (high fat diet) and switched to normal chow diet (obese diet → normal diet) or continued obese diet or normal diet throughout the experiment. A mouse model of OA was induced by surgical destabilization of the medial meniscus (DMM) model into the knee joint. Outcome measures included changes in metabolic factors such as glucose, insulin, lipid, and serum cytokines levels. Inflammation in synovial biopsies was scored and inflammation was determined using FACs sorted macrophages. Cartilage degeneration was monitored using histopathology. Our results indicate, dietary switching (obese diet → normal diet) reduced body weight and restored metabolic parameters and showed less synovial tissue inflammation. Systemic blood concentrations of pro-inflammatory cytokines IL-1α, IL-6, IL-12p40, and IL-17 were decreased, and anti-inflammatory cytokines IL-4 and IL-13 were increased in dietary switch group compared to mice that were fed with obesogenic diet continuously. Although obese diet worsens the cartilage degeneration in DMM OA model, weight loss induced by dietary switch does not promote the histopathological changes of OA during this study period. Collectively, these data demonstrate that switching obesogenic diet to normal improved metabolic syndrome symptoms and can modulate both systemic and synovium inflammation levels.
... A number of age-related cell and matrix changes occur within the cartilage [349,350], effectively reducing its ability to respond adequately to mechanical loading [350,351]. Both knee joint malalignment [352][353][354] and a higher body mass index [231,[355][356][357][358][359][360][361] are associated with greater compartmental knee loads and structural (adaptive and adverse) cartilage and bone changes. Furthermore, muscular weakness has an effect on reduced shock absorption and subsequent higher articular contact stresses [362], and quadriceps weakness in particular is associated with greater levels of knee joint loading during gait [363,364]. ...
Article
Full-text available
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, muscu-lotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions , and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and speci-ficity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation. Key Points Mechanical loads encountered during high-risk cutting, pivoting, and jumping sports predispose the structures of the knee to risk of injury. Individual tissues of the knee respond and adapt differently to various mechanical load stimuli. Appropriate selection of exercises, functional activities , and mobility tasks based on their mechanical load profile can be utilized during rehabilitation to systematically and progressively load the structure of the knee to promote tissue healing and repair.
... Additionally, adipose tissue is recognized as being metabolically active and pro-inflammatory; therefore, obesity may contribute to inflammation [6]. Weight reduction from an obese state is beneficial in the management of International Journal of Food Science and Agriculture osteoarthritis [7,8]. It may be possible to modify the inflammation by nutritional components as follows. ...
... It is unclear why obesity is associated with OA risk. Initially, it was postulated to be purely biomechanical, as studies demonstrated that extreme weight loss reduced joint loading in obese adults [32][33][34] , thereby possibly ameliorating symptoms and slowing cartilage degradation. However, obesity has also been linked to OA-development in non-weight-bearing joints, which suggests that non-mechanical risk factors may contribute to OA development 15,34 . ...
Article
Full-text available
Osteoarthritis is a debilitating disease characterized by cartilage degradation and altered cartilage mechanical properties. Furthermore, it is well established that obesity is a primary risk factor for osteoarthritis. The purpose of this study was to investigate the influence of obesity on the mechanical properties of murine knee cartilage. Two-month old wild type mice were fed either a normal diet or a high fat diet for 16 weeks. Atomic force microscopy-based nanoindentation was used to quantify the effective indentation modulus of medial femoral condyle cartilage. Osteoarthritis progression was graded using the OARSI system. Additionally, collagen organization was evaluated with picrosirius red staining imaged using polarized light microscopy. Significant differences between diet groups were assessed using t tests with p < 0.05. Following 16 weeks of a high fat diet, no significant differences in OARSI scoring were detected. However, we detected a significant difference in the effective indentation modulus between diet groups. The reduction in cartilage stiffness is likely the result of disrupted collagen organization in the superficial zone, as indicated by altered birefringence on polarized light microscopy. Collectively, these results suggest obesity is associated with changes in knee cartilage mechanical properties, which may be an early indicator of disease progression.
... For instance, the KFM has been shown to influence medial knee joint contact forces, 11,12 and baseline KFM values were shown to predict 5-year tibiofemoral cartilage changes in individuals with medial compartment knee OA. 10 However, another longitudinal study found no association between baseline peak KFM on any medial knee OA progression outcome measures after 2 years. 13 Patients with severe knee OA also exhibit smaller knee extension angles and a reduced KEM in late stance when compared with asymptomatic individuals and older individuals with moderate knee OA. 14 This has been hypothesized to be a compensatory strategy to increase knee joint stiffness and reduce the external load on the knee joint in individuals with knee OA. 15 Consequently, further investigation is required to better understand how the KFM and KEM may impact knee OA-related cartilage changes. ...
Article
The relationship between knee moments and markers of knee osteoarthritis progression has not been examined in different knee osteoarthritis subtypes. The objective was to examine relationships between external knee moments during gait and tibiofemoral cartilage thickness in patients with nontraumatic and posttraumatic knee osteoarthritis. For this cross-sectional study, participants with knee osteoarthritis were classified into two groups: nontraumatic (n = 22; mean age 60 years) and posttraumatic (n = 19; mean age 56 years, history of anterior cruciate ligament rupture). Gait data were collected with a three-dimensional motion capture system sampled at 100 Hz and force plates sampled at 2000 Hz. External knee moments were calculated using inverse dynamics. Cartilage thickness was determined with magnetic resonance imaging (T1-weighted, 3D sagittal gradient-echo sequence). Linear regression analyses examined relationships between cartilage thickness with knee moments, group, and their interaction. A higher knee adduction moment impulse was negatively associated with medial to lateral cartilage thickness ratio (B = −1.97). This relationship differed between participants in the nontraumatic osteoarthritis group (r = −0.56) and posttraumatic osteoarthritis group (r = −0.30). A higher late stance knee extension moment was associated with greater medial femoral condyle cartilage thickness (B = −0.86) and medial to lateral cartilage thickness (B = −0.73). These relationships also differed between participants in the nontraumatic osteoarthritis group (r = −0.61 and r = −0.51, respectively) and posttraumatic osteoarthritis group (r = 0.10 and r = 0.25, respectively). Clinical Significance: The relationship between knee moments with tibiofemoral cartilage thickness differs between patients with nontraumatic and posttraumatic knee osteoarthritis. The potential influence of mechanical knee loading on articular cartilage may also differ between these subtypes.
... It is not surprising that obesity was identified as a possible risk factor for bilateral medial tibiofemoral knee osteoarthritis. As the medial compartment sees the highest loading within a knee [28] and this loading is increased with obesity [29][30][31][32][33], it makes sense that obesity is a risk factor for this phenotype of osteoarthritis. It is interesting to see the strong heritability of this risk factor for this phenotype. ...
Article
Full-text available
To assess the potential of studying offspring of people with and without knee osteoarthritis to understand the risk factors and heritability for knee osteoarthritis. We selected two groups of Osteoarthritis Initiative (OAI) participants from one clinical site: (1) participants with bilateral radiographic medial tibiofemoral osteoarthritis and (2) those without tibiofemoral osteoarthritis. We then invited biological offspring ≥ 18 years old to complete an online survey that inquired about osteoarthritis risk factors and symptoms. Among the survey respondents, we recruited ten offspring of members from each group for a clinic visit with bilateral knee posterior-anterior radiographs and magnetic resonance imaging of the right knee. We established contact with 269/413 (65%) eligible OAI participants. Most (227/269, 84%) had ≥ 1 eligible biological offspring, and 213 (94%) were willing to share information about the new family study with their offspring. Our survey was completed by 188 offspring from 110 OAI participants: mean age of 43.0 (10.4) years, mean body mass index of 23.7 (5.9) kg/m², 65% female. Offspring obesity (OR = 2.7, 95% CI 1.0–7.3), hypertension (OR = 3.7, 95% CI 1.2–11.3), and Heberden’s nodes (OR = 3.6, 95% CI 1.0–13.2) were associated with parental osteoarthritis status; however, adjusted models were not statistically significant. Radiographic tibiofemoral osteoarthritis (16/18 knees vs. 2/20 knees) and meniscal abnormalities (7/9 vs. 2/10 index knees) were more common among offspring with parental osteoarthritis status than not. We established the potential of a novel offspring study design within the OAI, and our results are consistent with bilateral radiographic medial tibiofemoral osteoarthritis being a heritable phenotype of osteoarthritis.
... Weight loss is a particularly important management strategy for OA because of its well-documented impact on reducing musculoskeletal pain (4). For example, a 10-pound weight loss has been shown to reduce knee joint loading by 40 pounds, thereby decreasing the risk of OA by 50% (5)(6)(7). Moreover, diet-induced weight loss reduces systemic and synovial joint inflammation (8,9), which may lessen symptoms and cartilage destruction. ...
Article
Background For persons with osteoarthritis (OA), nutrition education may facilitate weight and OA symptom management. Objective The primary aim of this study was to determine preferred OA-related nutritional and weight management topics and their preferred delivery modality. The secondary aim was to determine if there is a disconnect between what patients want to know about nutrition and OA management, and what information healthcare professionals (HCPs) are providing to patients. Methods The Osteoarthritis Action Alliance surveyed individuals with OA to identify their preferences, categorized in four domains: 1) Strategies for weight management/healthy lifestyle; 2) Vitamins/minerals/other supplements; 3) Foods/nutrients that may reduce inflammation; and 4) Diets for weight loss. HCPs were provided these domains and asked which topics they discussed with patients with OA. Both groups were asked to select currently utilized or preferred formats of nutritional resources. Results Survey responses from 338 individuals with OA and 104 HCPs were included. Highest preference rankings in each domain were: 1) foods that make OA symptoms worse (65%), foods/nutrients to reduce inflammation (57%), and healthy weight loss (42%); 2) glucosamine (53%), vitamin D (49%), and omega-3 fatty acids (45%); 3) spices/herbs (65%), fruits/vegetables (58%), and nuts (40%); and 4) Mediterranean diet (21%), low-carbohydrate diet (18%) and fasting/intermittent fasting (15%). There was greater than 20% discrepancy between OA person-reported interests and HCP-reported discussions on: weight loss strategies, general information on vitamins/minerals, special dietary considerations for other conditions, mindful eating, controlling caloric intake or portion size, and what foods worsen OA symptoms. Most respondents preferred to receive nutrition information in a passive format and did not want information from social media messaging. Conclusions There is disparity between nutrition education content preferred by individuals with OA (which often lacks empirical support) and evidence-based topics being discussed by HCPs. HCPs must communicate evidence-based management of joint health and OA symptoms in patient-preferred formats.
... 16 Obesity accelerates the progression of OA by increasing the load on weight-bearing joints. 17 For example, every 1 kg of body weight is equivalent to adding 4 kg of load to the knee joint, 18 but the association between obesity and OA in non-weight-bearing joints is unclear. 19 Globally, it is estimated that there will be nearly 1.3 billion overweight and 573 million obese adults by 2030. ...
Article
A literature review to identify nutritional factors and the prevention and management of knee or hip osteoarthritis (OA) suggests that nutritional interventions offer some health benefits in OA through mechanisms such as weight loss, reduced inflammation, and antioxidant capacity. However, because data are limited with mixed results, high-quality evidence, including longitudinal studies and clinical trials, are needed to understand whether nutritional supplementation effectively prevents or manages OA. Therefore, healthcare professionals should consider promoting diets rich in fiber, including whole grains, fruit, vegetables, nuts, seeds, and legumes or dietary patterns such as the Mediterranean diet, to their patients to manage OA.
... Die Biomechanik eines Gelenkes wird determiniert durch anatomische und funktionelle Faktoren [143]. So zählt das Übergewicht zu einem der wichtigen Faktoren, welches nicht nur an der Entstehung (dreifach-vierfach höheres Risiko an OA zu erkranken) beteiligt ist, sondern auch die Progredienz der OA beschleunigt [136,141,154,155], denn für jedes Kilogramm weniger an Körpergewicht erniedrigt sich die Kontaktbelastung im Kniegelenk um ein Vierfaches [156]. Verletzungen am Knie erhöhen die Wahrscheinlichkeit einer Gonarthrose um das Vierfache [157]. ...
Thesis
Das grundlegende Ziel dieser Dissertation war es, Gelenkknorpel von jungen und alten porkinen Kniegelenken vor und nach einer tribologischen Belastung zu vergleichen. Hierfür wurde auf Kniegelenke aus dem örtlichen Schlachthof zurückgegriffen, der von 16 jungen (6 Monate) und 15 alten (5 Jahre) Schweinen stammte. Die folgenden Fragestellungen wurden hierbei untersucht: 1. Konnte an dem Gelenkknorpel Osteoarthrose nachgewiesen werden? Falls Osteoarthrose vorhanden gewesen sein sollte, wie stark war diese ausgeprägt? 2. Gab es einen statistisch belastbaren Unterschied zwischen dem Knorpelbelag der alten und jungen Schweine? 3. Konnte ein Unterschied im biomechanischen Verhalten nach einer tribologischen Belastung zwischen den jungen und alten Knorpelproben nachgewiesen werden? 4. Welchen Effekt auf der morphologischen Ebene hinterließ die tribologische Belastung an den Knorpelproben? Gab es einen Unterschied zwischen den jungen und alten Tieren im Hinblick auf diesen Effekt? Zur Beantwortung von 1. und 2. wurde unter Zuhilfenahme von radiologischen (Kellgren&Lawrence- Score), makroskopischen (ICRS-Score) und mikroskopischen (Little-Score) Bewertungskriterien der Knorpel beider Gruppen untersucht und verglichen. Hierbei konnte nachgewiesen werden, dass alte Kniegelenke osteoarthrotischen Veränderungen unterlagen und sich in allen drei Bewertungskriterien signifikant von jungen Kniegelenken unterscheiden. Im Anschluss (3.) wurde der Knorpel mit Hilfe eines tribologischen Prüfsystems - basierend auf dem Pin-on-Plate-Prinzip - getestet. Als Pin diente ein osteochondraler Zylinder aus der Femurkondyle, der sich oszillierend auf der korrespondierenden, quadratischen Plate aus dem Tibiaplateau bewegte. Mithilfe eines Höhenmessers wurde hierbei die kontinuierliche Abnahme der Knorpelhöhe der Proben während der 1108 Test-Zyklen (2,03 Stunden) andauernden Belastung gemessen. Hier konnte ebenfalls ein statistisch belastbarer Unterschied nachgewiesen werden. Im Mittel verloren junge Knorpelproben nach der tribologischen Belastung 0,86 mm und alte 0,50 mm an Knorpelhöhe. Eine negative Korrelation zwischen den Arthrose-Scores und der Höhenabnahme des Knorpels zeigte, dass je stärker der Knorpel von Osteoarthrose befallen war, er umso weniger an Höhe während der tribologischen Testung verlor. Für 4. wurde mit denselben makro- und mikroskopischen Bewertungskriterien der Effekt der Belastung auf die jeweilige Gruppe evaluiert und beide Gruppen miteinander verglichen. Der makro- sowie mikroskopisch erkennbare Effekt führte in beiden Gruppen zu einem signifikanten Anstieg des Scores im Vergleich zur Situation vor der Belastung. Auf der tibialen (Plate-) Seite war eine ausgeprägte Riefenbildung erkennbar, welche in der jungen Gruppe stärker zur Geltung kam. Ein eigener, adaptierter Score, bei dem der Fokus der mikroskopischen Veränderungen ausschließlich auf den durch die Reibeversuche verursachten Effekte auf der Oberfläche des Knorpels und nicht auf degenerativen Prozessen lag, konnte in der Situation nach Belastung kein Unterschied zwischen den beiden Gruppen feststellen. Die Ergebnisse dieser Dissertation lassen die Interpretation zu, dass arthrotischer Knorpel resistenter gegenüber mechanischen Beanspruchungen ist, als junger. Diskutiert werden sollte, inwieweit dem tribologischen Prüfsystem mit seiner Pin-on-Plate Konfiguration ein eventueller Einfluss auf die Ergebnisse zugeschrieben werden muss. Die vielversprechenden Ergebnisse dieser Dissertation sollten in weiterführenden Projekten verfolgt werden, da sie wichtige Charakterisierungen der Biomechanik des Knorpels liefern können.
... Losing weight yields a decrease of the pressure on the knee joint, improving physical function and biomechanics, combined with exercise. Research on biomechanics highlighted that a decrease in weight of 1 kg produces quadruple reduction of the forces acting on the knee (11). For subjects exhibiting OA symptoms, an amelioration of the symptoms has often been observed through weight loss only. ...
Article
Full-text available
Osteoarthritis (OA) is a common, frequently met degenerative disease, that generates pain and decreasing functionality; risk of suffering from this disorder increases with ageing. Being a complex disease, treatment is often difficult due to complications. Knee OA therapy demands a strategy that specialists agree with in considering the clinical symptoms and the disease evolution. The initial management of its treatment should be conservative requiring both a pharmacological and a non-pharmacological approach. If this conservative, noninvasive therapy fails, the surgical approach is discussed. The present review focused on the assessment of therapy choices for patients with knee OA, in order to reduce pain and enhance functionality and knee range of motion, underlying benefits and advantages for each choice. Existing data of available treatment for knee OA, both surgical and nonsurgical were analyzed, focusing on the latest results, indications , developments, and level of evidence provided by the literature in the topic.
... For every pound of weight loss, there is a fourfold reduction on the knee load per step [40]. Higher BMI may lead to higher tibio-femoral loads, placing further stress on the implant interface and increasing the risk of early aseptic loosening [41]. ...
Article
Full-text available
Background Although metal-backed tibial component (MB) is biomechanically superior to all-polyethylene (AP) implants in fixed-bearing unicompartmental knee arthroplasty (UKA), recent studies have shown comparable functional outcomes between the two. However, no study has examined this comparison in obese patients (BMI ≥ 30 kg/m²). We investigated whether functional outcomes between the two implants differ among obese patients, and whether the extent of obesity influences these outcomes. Patients and methods Four hundred twenty-two UKA implants from 347 obese patients were reviewed retrospectively. Patients were assessed using the Knee Society Knee Score (KSKS) and Function Score (KSFS), the original Oxford Knee Score (OKS), and SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS). Minimal clinically important difference (MCID) attainment was recorded. Patients’ fulfillment of expectations and satisfaction with the surgery outcome was also graded. Patients were further divided into lower obesity (BMI 30–34.9 kg/m²) and higher obesity (BMI ≥ 35 kg/m²) to examine effect modification. Results There were no differences in functional outcomes and quality-of-life scores, MCID attainment of functional scores, as well as satisfaction and expectation fulfillment between AP and MB. Among higher obesity patients, AP was associated with a poorer KSKS (p = 0.031) and lower proportion of satisfaction fulfillment (p = 0.041) 2 years postoperatively compared to MB. Conclusion We found no differences in functional and quality-of-life outcomes between fixed-bearing AP and MB tibial components among obese patients who underwent UKA. However, among higher obesity patients (BMI ≥ 35 kg/m²), patients with AP tibial component were associated with lower KSKS score and a lower proportion of attaining satisfaction fulfillment 2 years postoperatively.
... In addition to the reported maximum stress concentration in cartilage and its relative, concluded role in risk evaluation of the knee OA initiation and progression, the musculoskeletal FE analysis proposed in this investigation may help understand the earlier observed OA reduced risk associated with weight loss [62] if it is simulated under the proper boundary conditions. Furthermore, scaling this simulation pipeline via the measured subject's anatomical dimensions and driving the mechanical knee reaction by the same subject 3D motion capture, as well as considering tissue regular and degenerated responses, will provide the clinicians and therapists with an innovative tool that may help design the subject's rehabilitation protocol. ...
Article
Full-text available
Knee osteoarthritis (OA) is a growing source of pain and disability. Obesity is the most important avoidable risk factor underlying knee OA. The processes by which obesity impacts osteoarthritis are of tremendous interest to osteoarthritis researchers and physicians, where the joint mechanical load is one of the pathways generally thought to cause or intensify the disease process. In the current work, we developed a hybrid framework that simultaneously incorporates a detailed finite element model of the knee joint within a musculoskeletal model to compute lower extremity muscle forces and knee joint stresses in normal-weight (N) and obese (OB) subjects during the stance phase gait. This model accounts for the synergy between the active musculature and passive structures. In comparing OB subjects and normal ones, forces significantly increased in all muscle groups at most instances of stance. Mainly, much higher activation was computed with lateral hamstrings and medial gastrocnemius. Cartilage contact average pressure was mostly supported by the medial plateau and increased by 22%, with a larger portion of the load transmitted via menisci. This medial compartment experienced larger relative movement and cartilage stresses in the normal subjects and continued to do so with a higher level in the obese subjects. Finally, the developed bioengineering frame and the examined parameters during this investigation might be useful clinically in evaluating the initiation and propagation of knee OA.
... For instance, the KFM has been shown to influence medial knee joint contact forces, 11,12 and baseline KFM values were shown to predict 5-year tibiofemoral cartilage changes in individuals with medial compartment knee OA. 10 However, another longitudinal study found no association between baseline peak KFM on any medial knee OA progression outcome measures after 2 years. 13 Patients with severe knee OA also exhibit smaller knee extension angles and a reduced KEM in late stance when compared with asymptomatic individuals and older individuals with moderate knee OA. 14 This has been hypothesized to be a compensatory strategy to increase knee joint stiffness and reduce the external load on the knee joint in individuals with knee OA. 15 Consequently, further investigation is required to better understand how the KFM and KEM may impact knee OA-related cartilage changes. ...
Article
Objective Although pain-related fear and catastrophizing are predictors of disability in low back pain (LBP), their relationship with guarded motor behavior is unclear. The aim of this meta-analysis was to determine the relationship between pain-related threat (via pain-related fear and catastrophizing) and motor behavior during functional tasks in adults with LBP. Methods This review followed PRISMA guidelines. MEDLINE, Embase, PsychINFO and CINAHL databases were searched to April 2021. Included studies measured the association between pain-related fear or pain catastrophizing and motor behavior (spinal range of motion, trunk coordination and variability, muscle activity) during movement in adults with nonspecific LBP. Studies were excluded if participants were postsurgery or diagnosed with specific LBP. Two independent reviewers extracted all data. The Newcastle-Ottawa Scale was used to assess for risk of bias. Correlation coefficients were pooled using the random-effects model. Results Reduced spinal range of motion during flexion-tasks was weakly related to pain-related fear (15 studies, r = −0.21, 95% CI = −0.31 to −0.11) and pain catastrophizing (7 studies, r = −0.24, 95% CI = −0.38 to −0.087). Pain-related fear was unrelated to spinal extension (3 studies, r = −0.16, 95% CI = −0.33 to 0.026). Greater trunk extensor muscle activity during bending was moderately related to pain-related fear (2 studies, r = −0.40, 95% CI = −0.55 to −0.23). Pain catastrophizing, but not fear, was related to higher trunk activity during gait (2 studies, r = 0.25, 95% CI = 0.063 to 0.42). Methodological differences and missing data limited robust syntheses of studies examining muscle activity, so these findings should be interpreted carefully. Conclusion This study found a weak to moderate relationship between pain-related threat and guarded motor behavior during flexion-based tasks, but not consistently during other movements. Impact These findings provide a jumping-off point for future clinical research to explore the advantages of integrated treatment strategies that target both psychological and motor behavior processes, compared to traditional approaches.
... A study suggested that the reduced weight may be related to less demand on the proximal muscles and the internal medial rotator muscle of the knee, to provide stability at the toe-off during excessive rearfoot motion [11]. A recent exposition led to the fact that by acquiring the habit of regular exercise, knee OA patients can reduce pain and improve the quality of life and physical activity. ...
Article
Full-text available
Background. Osteoarthritis (OA) of the knee is defined as a progressive disease of the synovial joints and is characterized by wear and tear of the cartilage and underlying bone. This study aimed to determine the short-term effects of the lower limb rehabilitation protocol (LLRP) on pain, stiffness, physical function, and body mass index (BMI) among knee OA participants who were overweight or obese. Methodology. A single-blinded randomized controlled trial of one-month duration was conducted at Rehmatul-Lil-Alameen Postgraduate Institute, Lahore, Pakistan. Fifty overweight or obese participants with knee OA were randomly divided into two groups by a computer-generated number. Participants in the rehabilitation protocol group (RPG) were provided with leaflets explaining the strengthening exercises of the LLRP and instruction of daily care (IDC), while the participants in the control group (CG) were provided with leaflets explaining the IDC only for a duration of four weeks. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function. The secondary outcome measures were BMI, exercise adherence, and patients’ satisfaction assessed by using the numeric rating scale ranging from 0 to 10. The paired-sample t-test was used to analyze the differences within groups from baseline to posttest evaluations. The analysis of variance 2 × 2 factor was used to analyze the differences in BMI, knee pain, stiffness, and physical function between the groups. Results. Participants in the RPG and CG reported a statistically significant reduction in knee pain and stiffness () within the group. The reduction in the scores of knee pain was higher in participants in the RPG than that in participants in the CG (). Additionally, participants in the RPG reported greater satisfaction () and higher self-reported exercise adherence () and coordinator-reported exercise adherence () than the participants in the CG. Conclusion. Short-term effects of the LLRP appear to reduce knee pain and stiffness only, but not physical function and BMI. 1. Introduction The knee joint is a complex synovial joint in the human body where the femur, tibia, fibula, and patella articulate [1]. Articulation is supported by structures that include the muscles, ligaments, tendons, articular cartilage, synovial membrane, synovial capsule, meniscus, and fat pad [2]. The synovial fluid and articular cartilage lubricate the knee allowing low-friction joint movement [3]. The articular cartilage protects the subchondral bone from local stresses because of its strong reported excessive joint load in knee osteoarthritis (OA) [4]. A study provides evidence on the fact that excessive joint load in knee osteoarthritis (OA) patients can lead to an increased inflammatory response, joint pain, and swelling [5]. A recent study compared the body mass index (BMI) of obese and nonobese knee OA elderly individuals and reported that obesity resulted in less functional mobility, slower gait speed, higher pain intensity, and difficulty in performing daily living activities than nonobese individuals [6]. It was reported that obesity increases the joint load in knee OA patients, resulting in lowering functional mobility and increasing pain intensity. Over the past decade, the prevalence rate of overweight and obesity has increased in the United States of America (USA), Canada, Mexico, France, and Switzerland [7]. However, the prevalence of obesity solely among men and women of the USA population was 37.9 and 41.1%, respectively [8]. A recent retrospective study investigated the physical and functional characteristics of 320 patients with knee OA, reporting that obesity and advanced age were associated with an increased risk of knee OA [9]. Yet another study in the perspective under discussion reached the conclusion that overweight and obesity had a negative impact on increasing pain perception among patients with OA [10]. A study suggested that the reduced weight may be related to less demand on the proximal muscles and the internal medial rotator muscle of the knee, to provide stability at the toe‐off during excessive rearfoot motion [11]. A recent exposition led to the fact that by acquiring the habit of regular exercise, knee OA patients can reduce pain and improve the quality of life and physical activity. One of the defense mechanisms of the knee, such as body weight control, is useful for healthy aging [9]. All international clinical practice guidelines recommend patients with knee OA, who are overweight or obese, to lose their weight. Adherence may refer to different things and can be used to evaluate the attendance, technique, or accuracy of exercise protocols in supervised appointments [12]. Research in the context of adherence refers to the accomplishment of self-reported and coordinator-reported adherence by the intervention groups. Clinical guidelines recommend exercise therapy as the primary nonpharmacologic treatment for knee OA [13]. Because of remarkable evidence demonstrating the beneficial effects of physical exercise among patients with OA, exercise is often indicated as one of the main components in the rehabilitation process [14, 15]. Among the several types of physical exercise programs, muscle strengthening is important because of the relationship between muscle weakness, pain, and malfunction [16, 17]. A current systematic review on nonpharmacological interventions for treating symptoms of knee OA in overweight or obese patients resulted that the most effective intervention that showed improvement of knee pain and function was strengthening exercise. Similarly, it also reported that the combination of diet and exercise was found effective in reducing weight and improving knee pain [18]. A study explained that progressive resistance strength training increases the load gradually over the training course to strengthen the major muscle groups and has been recommended to prevent or reduce late-life disability for older adults [19]. The effectiveness of rehabilitation in non-weight-bearing positions as well as strengthening exercises of major muscle groups of the lower limbs may provide more objective data than the standard rehabilitation approaches we are using today to treat overweight and obese knee OA patients. However, there is a gap in knowledge regarding whether strengthening exercises of major muscle groups of lower limbs in non-weight-bearing positions can improve the effects of rehabilitation among overweight or obese knee OA participants. Hence, the current randomized controlled trial aimed to determine the short-term effects of strengthening exercise of the lower limb rehabilitation protocol (LLRP) in non-weight-bearing positions on knee pain, stiffness, physical function, BMI, patients’ satisfaction, and exercise adherence in overweight or obese knee OA participants. The current study aimed to determine the short-term effects of strengthening exercises of LLRP in non-weight-bearing positions on pain, stiffness, physical function, BMI, patients’ satisfaction, and exercise adherence in overweight or obese knee OA participants. 2. Methodology 2.1. Design and Setting This is a single-blinded randomized controlled trial that involved participants diagnosed with knee OA who are overweight or obese. Participants were randomized into the rehabilitation protocol group (RPG) and the control group (CG) using a computer-generated simple randomization technique. The study was conducted at the teaching bay of Rehmatul-Lil-Alameen Postgraduate Institute of Cardiology (RAIC), Punjab Employees Social Security Institution (PESSI), Lahore, Pakistan. All participants were asked to complete the clinical research form (CRF) following randomization. The CRF gathered sociodemographic information, symptoms of knee pain and stiffness, physical function scores, and BMI. The participants’ satisfaction and exercise adherence were collected after four weeks of intervention. Participants in each treatment group were provided with necessary details about their intervention protocol after randomization. Making explanation of the purpose and constraints of the study, the participants were asked to provide written informed consent for their participation in the study. All participants were also given a diary and asked to record the attendance of completion of their interventions based on leaflets. The current study was approved by the ethical committee of Rehmatul-Lil-Alameen Postgraduate Institute of Cardiology, Punjab Employees Social Security Institution, with reference number RAIC PESSI/Estt/2020/36 on 20-05-2020, and the trial was registered in the Iranian Registry of Clinical Trials with reference number https://trialsearch.who.int/?TrialID=IRCT20191221045846N2 on 28-06-2020. 2.2. Study Participants, Recruitment, and Selection Participants with knee OA who were overweight or obese from the urban community of Punjab, Lahore, Pakistan, were screened. The sample included males and females with OA on one or both knees as confirmed by a medical specialist according to the Kellgren and Lawrence radiographic scale for the assessment of OA [20]. Plain radiography was performed to obtain anteroposterior and lateral views of the affected knee/knees in the standing position at the Al-Rehmat Trust Hospital, Lahore. Participant inclusion criteria were as follows:(i)Aged between 45 and 60 years(ii)Having minimum qualification of matriculation(iii)History of knee pain for more than three months(iv)Overweight (BMI ≥ 25 kg/m²) or obese (BMI > 30 kg/m²) [21](v)Diagnosed with mild or moderate knee OA according to the Kellgren and Lawrence radiographic scale [20] Participant exclusion criteria were as follows:(i)Diagnosed with rheumatoid arthritis, systemic lupus erythematosus, flat foot/feet, or spinal deformities(ii)History of metabolic, hormonal, orthopaedic, or cardiovascular disease(iii)Previous surgery of the knee/s [22](iv)Inability to walk independently(v)Injection of knee/s for the last six months [22] All information related to inclusion and exclusion criteria was gathered from the predefined questionnaire.The researcher recruited the participants by using active recruitment strategies such as urban political and welfare organizations via word of mouth by the convenience sampling technique. The list of participants with knee OA in the studied area was obtained from the welfare organization by explaining the benefits of study participation. Two study coordinators prepared the list of potential participants with knee OA in the recruitment area. After obtaining the list of potential participants with knee OA, the researcher arranged a meeting with the knee OA participants by calling them on the phone. The meeting was held at the teaching bay of RAIC, PESSI, Lahore, Pakistan, in the presence of a medical specialist. Participants were screened for eligibility to participate in the study. Only participants fulfilling the inclusion criteria of the study were invited to participate in this study. 2.3. Sample Size Sample size estimation was performed using the G∗ Power 3.1.3 software. By assuming the medium effect size f = 0.70 and setting α = 0.05, power (1 − B) = 0.80, number of groups = 2, and number of measurements = 2, the total sample size estimated was 33 participants. After considering the apprehension of dropout or mortality during the research period, the sample size of 50 participants for the two groups was decided. 2.4. Blinding and Allocation The principle investigator was not blinded in the study. The participants receiving the intervention were kept blinded by simply not informing them of their treatment allocation. The coordinators collecting data were independent individuals from the trials and were unaware of the group allocation. There were different coordinators at the baseline and posttest evaluation. Individuals performing the statistical analysis were kept blinded by labelling the groups with nonidentifying terms (such as X and Y). 2.5. Study Randomization After completing the screening of knee OA participants, the researcher allocated 50 selected participants into two groups, namely, RPG and CG, by using a computer-generated number. Each group consisted of 25 participants. The participants receiving the intervention were blinded by their treatment allocation. The participants in the RPG followed the strengthening exercise of the LLRP and followed the instructions of daily care (IDC) for a duration of 4 weeks. The participants in the CG were not involved in the rehabilitation protocols, but these participants only followed the IDC for a duration of 4 weeks. 2.6. Research Procedures 2.6.1. Research Procedure of the RPG The researcher taught the strengthening exercises of the LLRP and IDC to the RPG for a duration of four weeks. Participants were advised to continue performing the strengthening exercises of the LLRP three times a week for four weeks at home. These training sessions included strengthening exercises for the lower limbs in non-weight-bearing, sitting, or lying positions. Each training session started with 10 minutes of warm-up, 45–60 minutes of lower limb resistance training, and 10 minutes of cooldown at the end of the training protocol.A cooldown period is essential after a training session and should last approximately 5–10 minutes [23, 24]. When static stretching is used as a part of warm-up immediately prior to exercise, it causes harm to muscle strength [25]. The participants in the RPG performed the strengthening exercises of the LLRP and followed the IDC at home for four weeks. The contents of the IDC are explained in a recent randomized controlled trial [22]. The sequence of the training program started with 10 minutes of warm-up with whole body range of motion (ROM) and dynamic stretching exercises (Table 1). The participants performed 10 repetitions of ROM exercises for each muscle group and five repetitions of dynamic stretching exercises for each muscle group as a part of warm-up. After the warm-up, the participants performed the strengthening exercises of the LLRP for the stipulated weeks as stated in Table 2. After completing the strengthening exercises, the participants performed the 10-minute cooldown with whole body ROM and static stretching exercises (Table 1). The participants performed 10 repetitions of ROM exercises for each muscle group and three repetitions of static stretching exercises for each muscle group as a part of cooldown. Body part ROM exercises Neck Flexion and extension, side flexion to the right and then to the left, and neck rotation to the right and then to the left Shoulder Shoulder flexion and extension, shoulder abduction and adduction, and shoulder rotation Elbow Elbow flexion and extension Wrist Wrist flexion and extension Spine Spine flexion and extension and spine rotation to the right and then to the left Hip Hip abduction and adduction and hip flexion and extension Knee Knee flexion and extension Ankle Ankle dorsiflexion and plantar flexion 10 repetitions of each muscle group’s ROM exercises will be performed before and after the intervention period ROM, range of motion.
... The beneficial effects of weight reduction can be explained by biomechanical and biochemical issues. Weight loss reduces the load exerted on joints (33). Increased adipose tissue has been associated with local and systemic inflammation (23). ...
Article
Full-text available
The principle of ketogenic diet (KD) is restriction of carbohydrates to a maximum of 5–10% of the total daily caloric intake, aiming at shifting body metabolism toward ketone bodies. Different studies suggested promising results of KD to help patients to lose weight, to reduce insulin requirements in diabetes, to supplement cancer protocols, to treat neurological conditions and to optimize control of metabolic and cardiovascular diseases. However, literature about the anti-inflammatory properties of KD in rheumatic diseases is still limited. The beneficial effects of weight loss in patients with inflammatory arthritis can be explained by biomechanical and biochemical factors. Obesity is associated with macrophage activation and production of pro-inflammatory cytokines including TNF-α, IL-1b, and IL-6. The clinical effect of KD may be primarily attributed to improvement of insulin sensitivity. Insulin resistance is associated with an increase of TNF-α, IL-1α, IL-1β, IL-6, and leptin. Moreover, reduction of body's adipose tissue and weight loss account for part of the anti-inflammatory effects and for the impact of KD on cardiovascular health. In rheumatoid arthritis, fasting was shown to be effective in reducing disease symptoms, possibly through the production of β-hydroxybutyrate (BHB), the main ketone body. BHB may exert inhibitory effects also on IL-17 and intermittent fasting improved the clinical manifestations of psoriatic arthritis. In ankylosing spondylitis, current literature doesn't allow to draw conclusion about the effects of KD. Future prospective studies will be needed to elucidate the potential beneficial effects of KD on specific domains and clinical outcomes in patients with inflammatory arthritis.
... Когортне досліджен-ня Messier та співавт . [51] показало співвідношення втрати маси тіла 1 : 4 до зменшення навантаження на колінний суглоб, що вказує на те, що втрата 1 кг маси тіла призведе до зниження механічного навантаження на колінний суглоб на 4 кг під час ходьби . ...
Article
Full-text available
За останні 30 років у всьому світі кількість хворих на ожиріння зросла більш ніж удвічі. До змін в опорно-руховому апараті, що спричинені ожирінням, слід віднести дегенеративні та запальні ураження, і найчастіше це – остеоартроз. Остеоартроз впливає на всі аспекти життя через біль і обмеження рухливості, тому проблема лікування таких пацієнтів залишається актуальною. Методи. Аналіз літературних джерел відносно впливу ожиріння на розвиток остеоартрозу на основі змін рівня клінічних та інструментально-діагностичних аспектів. Результати. Остеартроз є не просто хворобою старіння суглобів, а скоріше він спричинений процесом метаболічних порушень, при якому різні ліпідні, метаболічні та гуморальні медіатори запалення сприяють ініціації і прогресуванню процесу захворювання. Пацієнти з ожирінням та остеоартрозом, які втрачають вагу, можуть спостерігати зменшення симптомів остеоартрозу. Автори зазначають, що втрата ваги у таких пацієнтів пов’язана зі зменшенням таких запальних чинників, як C-реактивний білок (CRP), фактор некрозу пухлини (TNF) і інтерлейкін-6 (IL-6), які були пов’язані з порушенням фізичної функції.
... Reduction in the body weight not only has a preventive role, but also in relieving pain in the patients suffering from osteoarthritis. Each pound of weight lost results in a 4fold reduction in the per step load exerted on the knee [16]. Presence of this belief in the community is important as it can promote adoption of healthy dietary habits and reduce the large number of problems associated with obesity, osteoarthritis being one of them. ...
Article
Background : Government funded hospitals are believed to be stigmatised with ‘substandard care’ and constant fear of infection. The aim of this study is to compare the results and direct expenditure incurred for total knee arthroplasty (TKA) done at a government funded public teaching hospital with an economy packaged private hospital in India. Materials and Methods: A review of electronic and physical records of the patients operated by the senior author for primary TKA at a government funded hospital and a private hospital spanning 2007 to 2019 was done. A retrospective cohort study was designed matching the implant design and the ASA grade of the patients. Knee injury and Osteoarthritis Outcome Score (KOOS), Hospital for Special Surgery score (HSS), Knee Society Score (KSS) at 2 years follow-up were the primary outcome parameters. The retrieved data describing the cost of surgery and perioperative complications were analyzed. The confounders were minimized by including only the surgeries performed by the author, using the same instruments and implants in similar operating theatre environments. Results: This study involved two cohorts comprising 280 patients each, with no differences in gender, ASA grade and primary diagnosis. There was no significant difference in the 2-year HSS, KSS and KOOS score between the two groups. The 2-year cumulative incidence of major and minor complications in both the study cohorts showed no significant difference. The mean cost of an uncomplicated primary TKA (2019) in government hospital was 1NR. 85,927; 39.476% of that required in a private setup (INR. 2,17,667). Conclusion Affordable TKA package in a government funded hospital can produce results comparable to that in a private hospital setup at a reasonably lower cost without increasing the complication rates.
Article
Background: A well-known association exists between obesity and knee osteoarthritis (OA) for both incidence and progression of the disease. However, the cartilage wear patterns in OA associated with obesity are less well studied. Methods: The OA initiative, a prospective sample of 4,796 patients, was used for this study. After the application of inclusion and exclusion criteria, patients were stratified into increasing body mass index (BMI) cohorts (BMI < 25, 25 ≤ BMI < 30, 30 ≤ BMI < 40, and 40 ≤ BMI). Knee MRIs were assessed using the semiquantitative MRI Osteoarthritis Knee Score scores. Patellofemoral (PF), medial, and lateral compartment cartilage scores were compared among BMI cohorts, controlling for confounders using linear regression models. Results: In total, 2,006 patients were present in our cohort, 773 men (38.5%) and 1,233 women (61.5%); the mean age was 61.7 ± 8.9 years. Increasing BMI was independently associated with increasing grades of PF wear for both right and left knees in the lateral patella facet (right knee β: 0.208, 95% confidence interval [CI]: 0.128 to 0.288, P < 0.001, left knee β: 0.147, 95% CI: 0.056 to 0.237, P = 0.002), medial femoral trochlea (right knee β: 0.135, 95% CI: 0.065 to 0.204, P < 0.001, left knee β: 0.142, 95% CI: 0.063 to 0.221, P < 0.001), and lateral femoral trochlea (right knee β: 0.163, 95% CI: 0.093 to 0.232, P < 0.001, left knee β: 0.147, 95% CI: 0.067 to 0.226, P < 0.001). For the right knee, increasing BMI was associated with medial compartment wear in the posterior femoral area (β: 0.070, 95% CI: 0.015 to 0.126, P = 0.013) and lateral compartment wear in the central tibial area (β: 0.070, 95% CI: 0.002 to 0.138, P = 0.045). For the left knee, increasing BMI was associated with medial compartment wear in the central femoral area (β: 0.093, 95% CI: 0.016 to 0.171, P = 0.018). Discussion: Obesity is preferentially associated with increasing cartilage wear in the PF compartment in comparison to the tibiofemoral compartment. Physical therapy and exercise programs that promote weight loss should be modified to decrease forces on the PF joint.
Thesis
Full-text available
The quantification and analysis of human movement have constantly challenged researchers, clinicians and coaches during the last centuries. While it was a time-consuming and cumbersome task at the beginning, advancements in processing power and technology allowed to develop more complex and accurate measurement and analysis techniques over time. To mention only the most frequently used technologies, these range from three-dimensional (3D) motion-capturing, sophisticated medical-imaging based personalized biomechanical modelling, the quantification of muscle activation via surface electrodes, to the application of advanced data-science driven methods on big data. This cumulative habilitation thesis describes research in biomechanics relevant to gait analysis and motor rehabilitation which utilizes sophisticated biomechanical measurement techniques combined with emerging and innovative technologies to aid clinical practice and decision-making. More specifically, the presented research includes the following contributions: (i) using electromyographic analysis to understand muscle activation patterns during rehabilitation exercises and walking, (ii) investigations in methodological aspects of clinical 3D gait analysis in overweight and obese children and adolescents, (iii) the application of standard clinical 3D gait analysis to quantify intervention effects in a randomized-controlled trial, (iv) the prototyping and evaluation of an in-shoe real-time sonification feedback device for gait rehabilitation, and (v) the application and optimization of machine learning techniques to automatically identify specific gait patterns in gait analysis data. Even though the utilized techniques in this thesis are highly developed, there are still technical limitations that hamper knowledge generation when using them. However, technological advancements and innovations are still ongoing. Therefore, in the final chapter this thesis will give an outlook to what can be expected in the near future and to where research and development in the field of applied biomechanics are currently advancing.
Article
The mechanical environment of the joint during dynamic activity plays a significant role in osteoarthritis processes. Understanding how the magnitude, pattern and duration of joint-specific loading features contribute to osteoarthritis progression and response to treatment is a topic of on-going relevance. This narrative review synthesizes evidence from recent papers that have contributed to knowledge related to three identified emerging subthemes: i) the role of the joint mechanical environment in osteoarthritis pathogenesis, ii) joint biomechanics as an outcome to arthroplasty treatment of osteoarthritis, and iii) methodological trends for advancing our knowledge of the role of biomechanics in osteoarthritis. Rather than provide an exhaustive review of a broad area of research, we have focused on evidence this year related to these subthemes. New research this year has indicated significant interest in using biomechanics investigations to understand structural versus clinical progression of osteoarthritis, the role and interaction in the three-dimensional loading environment of the joint, and the contribution of muscle activation and forces to osteoarthritis progression. There is ongoing interest in understanding how patient variability with respect to gait biomechanics influences arthroplasty surgery outcomes, and subgroup analyses have provided evidence for the potential utility in tailored treatment approaches. Finally, we are seeing a growing trend in the application of translational biomechanics tools such as wearable inertial measurement units for improved integration of biomechanics into clinical decision-making and outcomes assessment for osteoarthritis.
Article
Background Adaptations within the phenylalanine (PHE)/tyrosine (TYR) pathway during nitisinone (NIT) are not fully understood. Objective To characterise the temporal changes in metabolic features in NIT-treated patients with alkaptonuria. Patients and methods Serum (s) and 24-urine (u) homogentisic acid (sHGA, uHGA24), TYR (sTYR, uTYR24), PHE (sPHE, uPHE24), hydroxyphenylpyruvate (sHPPA, uHPPA24), hydroxyphenyllactate (sHPLA, uHPLA24) and sNIT were measured at baseline (V1) and until month 48 (V6) in 69 NIT-treated patients, recommended to reduce protein intake. The 24-h urine urea (uUREA24), creatinine (uCREAT24) and body weight were also measured. Amounts of tyrosine metabolites in total body water (TBW) were derived by multiplying the serum concentrations by 60% body weight, and sum of TBW and urine metabolites resulted in combined values (c). Results uUREA24 and uCREAT24 decreased between V1 and V6 during NIT, whereas body weight and sNIT increased. Linear regression coefficient between uUREA24 and uCREAT24 was extremely strong (R = 0.84). sPHE, TBWPHE and cPHE24 increased gradually from V1 to V6. A decrease in cTYR24/cPHE24, sTYR/sPHE and TBWTYR/TBWPHE was seen from V2 to V6. Serum, 24-urine and combined TYR, HPPA and HPLA either remained stable or decreased from V2 to V6. Discussion The gradual increase in PHE suggests adaptation to increasing TYR during NIT therapy. The decrease in protein intake resulted in decreased muscle mass and increased weight gain. Conclusion Progressive adaptation by decreasing PHE conversion to TYR occurs over time during NIT therapy. A low protein diet results in loss of muscle mass but also weight gain suggesting an increase in fat mass.
Chapter
Knee pain is the second most frequently encountered musculo skeletal reason for a patient's visit to the PM&R clinics. Depending on the nature of the practice, etiology of the knee pain can be multi-factorial ranging from sports related injuries such as ligamentous sprains, meniscal injuries or osteoarthritis in a more aged population. Depending on the etiology treatment options vary.
Article
The aims of treatment for psoriatic arthritis (PsA) are to control inflammation, normalise functions and impacts on patients and prevent complications of the disease and its treatment. Over the past decade, treatment options for PsA have expanded with the availability of many more novel therapeutic agents. However, the treatment decisions and pathways for the use of these drugs are not always straightforward. There is a need to tailor the choice of medication to the individual patient, taking into account the type of their disease and consideration of other factors such as their co-morbidities. A treat to target approach is recommended with the aim to get the patient into a state of remission or low disease activity (whichever target is chosen). Both European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) have recently published updated guidance in 2018–2019. In this section, we will summarise the evidence for therapies in PsA and review the similarities and differences in these two sets of recommendations.
Article
Full-text available
Background Previous evidence has shown that seniors physical therapists applying electrotherapy and an enhanced therapeutic alliance in their sessions can positively influence the levels of analgesia of patients with chronic low back pain. It is currently unknown if these effects can be achieved in people with symptomatic knee osteoarthritis when receiving treatment focused on therapeutic exercise. Aim To determine the effects of different therapeutic alliance levels during the application of a therapeutic exercise program on pain intensity and pressure pain threshold in patients with symptomatic knee osteoarthritis. Method This will be a randomized, parallel, two-arm, clinical trial. An intervention of three sessions of therapeutic exercise will be applied for one week. Patients aged 45 to 65 years old with a clinical and radiographic diagnosis of knee osteoarthritis will participate. Also, patients with a pain intensity of at least three months duration and 3 to 8 points in a numerical rating scale will be included. Patients will be randomly assigned to a therapeutic exercise experimental group with an enhanced therapeutic alliance (e.g., active listening, personalized conversation, empathy) or limited therapeutic alliance (e.g., one-way verbalization, brief interaction). Physical therapists will be trained in delivering these two levels of the therapeutic alliance. The pressure pain thresholds at the symptomatic knee and the pain intensity will be measured before and after the intervention. Discussion The results of this research will determine the impact of the therapeutic alliance as a nonspecific relevant factor during the application of a therapeutic exercise program in the treatment of patients with symptomatic knee osteoarthritis. Clinical trials registration number NCT04390932
Preprint
Full-text available
Background This research aims at assessing the use of ultrasound in combination with a ayurvedic ani-inflammatory Zingiber Cassumunar gel, considering the parameters of physiotherapy on knee osteoarthritis. Zingiber cassumunar (ginger) has been used, for its anti-inflammatory properties, orally as well by it’s topical application. Improvement in pain, range of motion, balance and an overall quality of life in patients with osteoarthritis of knee has been studied through various physiotherapeutic exercises. In this study Otago exercise programme includes strengthening of lower limb and balance exercise along with walking protocol.Methodology: In this research we will include 52 subjects (n=52) having knee osteoarthritis between grade 1-3 according to Kallgren and Lawrence. In his randomized controlled single-blinded trial the subjects will be randomized into two group independent design (Group A and Group B) through envelope method of randomization. Group A will receive conventional therapy while Group B will be the experimental group. Efficacy of the intervention for both the groups is checked at the end of 2 weeks by using VAS, universal goniometer, WOMAC, star excursion balance test(SEBT) as the outcome measures.Discussion: The goal of this Randomized control trial is to examine the impact Zingiber Cassumunar phonophoresis in Knee osteoarthritis patients. This randomized control trial will help identify the rapid and long term effects of Zingiber Cassumunar phonophoresis on Knee osteoarthritis. This research findings will help develop a new prospect for the treatment of Knee osteoarthritis.The clinical trial registry-India(CTRI) registration number for this trial is CTRI/2021/05/033459.
Article
Objectives Osteoarthritis (OA) is a chronic degenerative musculoskeletal disease that causes articular damage and chronic pain, with a prevalence of up to 50% in individuals >60 years of age. Patients suffering from chronic painful conditions, including OA, also frequently report anxiety or depression. A systematic review and meta-analysis were performed to assess the correlation between pain severity and depressive and anxious symptomatology in OA patients. Methods A systematic search was conducted using four databases (PubMed, Medline, Scopus, and Web of Science) from inception up to 14th January of 2020. We included original articles evaluating pain severity and anxiety and/or depression severity in OA-diagnosed patients. Detailed data were extracted from each study, including patients’ characteristics and pain, anxiety, and depression severity. When available, the Pearson correlation coefficient between pain and depression severity and pain and anxiety severity was collected and a meta-analysis of random effects was applied. Results This systematic review included 121 studies, with a total of 38085 participants. The mean age was 64.3 years old and subjects were predominantly female (63%). The most used scale to evaluate pain severity was the Western Ontario and the McMaster Universities Osteoarthritis Index, while for anxiety and depression, the Hospital Anxiety and Depression Scale was the most used. The meta-analysis showed a moderate positive correlation between pain severity and both anxious (r = 0.31, p < 0.001) and depressive symptomatology (r = 0.36, p < 0.001). Conclusions Our results demonstrate a significant correlation between pain and depression/anxiety severity in OA patients, highlighting the need for its routine evaluation by clinicians.
Article
Background An upcoming total joint arthroplasty (TJA) may motivate patients with severe obesity (body mass index [BMI] > 40 kg/m²) to lose weight. Weight loss can optimize outcomes following TJA, and many surgeons use a 40 kg/m² cut-off for undergoing TJA to reduce the risk of complications. However, few patients who are denied TJA for severe obesity successfully lose weight. This is the first systematic review of nonsurgical weight loss interventions before TJA. Methods Five electronic databases were searched for articles on January 11, 2021. Studies that utilized preoperative nonsurgical weight loss interventions for patients with obesity (BMI ≥ 30 kg/m²) scheduled for or awaiting TJA of the hip or knee were included. Two reviewers independently screened articles, assessed methodological quality, and extracted data. Results We retrieved 1943 unique records, of which 7 met inclusion criteria including 2 randomized clinical trials and 5 single-arm case series. Overall, weight loss ranged from 5.0 to 32.5 kg. Four interventions reduced BMI by 3 kg/m² at 3-5 months, while 1 reduced BMI by 12.7 kg/m². Other weight outcomes and those related to pain, function, complications, and adverse events were inconsistently reported. Conclusion Although larger trials are needed, particularly randomized controlled trials that measure preoperative weight loss in a control group, nutritional status, and postoperative complications, the available evidence indicates that short-term, nonsurgical, preoperative weight loss interventions before TJA produce both statistically significant weight loss and reduced BMI before surgery. It remains unknown if the amount of weight loss from these interventions is clinically significant and sufficient to improve outcomes after TJA.
Article
Osteoarthritis (OA) is a common chronic inflammatory disease in the joints. It is one of the leading causes of disability with increasing morbidity, which has become one of the serious clinical issues. Current treatments would only provide temporary relief due to the lack of early diagnosis and effective therapy, and thus the replacement of joints may be needed when the OA deteriorates. Although the intra‐articular injection and oral administration of drugs are helpful for OA treatment, they are suffering from systemic toxicity, short retention time in joint, and insufficient bioavailability. Nanomedicine is potential to improve the drug delivery efficiency and targeting ability. In this focused progress review, the particle‐based drug loading systems that can achieve targeted and triggered release are summarized. Stimuli‐responsive nanocarriers that are sensitive to endogenous microenvironmental signals such as reactive oxygen species, enzymes, pH, and temperature, as well as external stimuli such as light for OA therapy are introduced in this review. Furthermore, the nanocarriers associated with targeted therapy and imaging for OA treatment are summarized. The potential applications of nanotherapies for OA treatment are finally discussed. Stimuli‐responsive particles‐based drug carriers that are sensitive to endogenousmicroenvironmental signals of osteoarthritis such as reactive oxygen species, enzymes, pH, and temperature, as well as external stimuli such as light can achieve targeted delivery and triggered release, showing great promise for the treatment of osteoarthritis.
Chapter
Die häufigsten Ursachen für die Notwendigkeit einer Hüftprothesen-Wechseloperation stellen die aseptische Lockerung dar, gefolgt von Luxationen, periprothetischen Infektionen und periprothetischen Frakturen. Diese Ursachen werden in diesem Kapitel näher beleuchtet.
Article
Full-text available
Functional knee braces used during rehabilitation from injury and surgery to the anterior cruciate ligament (ACL) have been reported to provide a strain-shielding effect on the ACL in healthy people while standing, reduce quadriceps electromyography in ACL-deficient individuals, and alter joint torque patterns in people with ACL reconstruction during walking. These results led to the hypothesis that functional knee braces protect a reconstructed ACL during dynamic activity by reducing the anterior shear load applied to the knee. This hypothesis was tested by investigating the effects of a functional knee brace on lower extremity muscle forces and the anteroposterior shear force at the knee joint during the stance phase of walking in people with ACL reconstruction. Ground reactions and sagittal plane video were recorded from 9 ACL-reconstructed individuals as they walked with and without a functional knee brace, and from 10 healthy people without the functional knee brace. Inverse dynamics were used to calculate the net joint torques in the lower extremity during the stance phase. Hamstrings, quadriceps, and gastrocnemius muscle and knee anteroposterior shear force were then predicted with a sagittal-plane mathematical model. Compared to healthy individuals, those with ACL reconstruction walked with 78% more hamstrings impulse and 19% less quadriceps impulse (both p < .05). The functional knee brace produced an additional 43% increase in hamstrings impulse and an additional 13% decrease in quadriceps impulse in the ACL group. Peak anterior knee shear force and anterior impulse were 41% lower and 16% lower in ACL vs. healthy individuals, respectively. The functional knee brace further reduced the peak knee shear force and impulse 28% and 19%, respectively, in the ACL group. It was concluded that a functional knee brace protects a reconstructed ACL during walking by altering muscle forces and reducing the anterior shear force applied to the knee joint.
Article
Full-text available
In our three-stage questionnaire study we investigated patterns oftwin and familial aggregation of osteoarthritis (OA) for commonly affectedjoints. The baseline questionnaire study of the Finnish Twin Cohort wasperformed in 1975. In 1990, 4095 twin pairs of the same gender born1930-1957 responded to a questionnaire and reported whether they hadOA diagnosed by a physician. In 1996 both twins of 266 pairs of which atleast one had reported OA in 1990 responded to a detailed questionnaire onjoint-specific OA, including family history of OA. In male pairs shared(non-genetic) familial effects accounted for 37% of the total variancein liability to OA and unshared environmental effects for 63%. In female pairsadditive gene effects explained 44% of the variance in liability to OA, andunshared environmental effects for 36%. Familial aggregation of finger andknee OA was clearly higher than that of hip OA. Twin-pair discordancefor OA was, to some extent, associated with body-mass index, occupationalloading and trauma. Our results indicate that genetic effects may be modulatedby sex or by environmental factors distributed differently between men and women.Based on our joint-specific data finger and knee joints are the most optimaltargets for studies of genetic factors predisposing to the development of OA.
Article
Full-text available
The natural history of knee osteoarthritis (OA) is poorly understood. The principal aim was to assess the rate of contralateral knee OA in middle aged women in the general population with existing unilateral disease and to identify the major factors that influence this rate. Fifty eight women aged (45-64) from a general population study cohort were identified with unilateral knee OA diagnosed radiologically (Kellgren and Lawrence 2+) (K&L). Follow up AP films were obtained at 24 months and compared with the baseline for K&L grade and individual features of osteophytes and joint space. Twenty women (34%) developed incident disease in the contralateral knee (based on K&L 2+ or osteophyte changes) and 22.4% (n = 13) of women progressed radiologically in the index joint. Obesity at baseline was the most important factor related to incident disease, 47% of women in the top BMI tertile developed OA, compared with 10% in the lowest tertile: relative risk 4.69 (063-34.75). No clear effect was seen for age, physical activity, trauma or presence of hand OA. Over one third of middle aged women with unilateral disease will progress to bilateral knee OA within two years and a fifth will progress in the index joint. Obesity is a strong and important risk factor in the primary and secondary prevention of OA. These natural history data provide a useful estimate for planning therapeutic intervention trials.
Article
Full-text available
To compare the cumulative 21 year incidence of admission to hospital for osteoarthritis of the hip, knee, and ankle in former élite athletes and control subjects. National population based study. Finland. 2049 male athletes who had represented Finland in international events during 1920-65 and 1403 controls who had been classified healthy at the age of 20. Hospital admissions for osteoarthritis of the hip, knee, and ankle joints identified from the national hospital discharge registry between 1970 and 1990. Athletes doing endurance sports, mixed sports, and power sports all had higher incidences of admission to hospital for osteoarthritis than controls. Age adjusted odds ratios compared with controls were 1.73 (95% confidence interval 0.99 to 3.01, P = 0.063) in endurance, 1.90 (1.24 to 2.92, P = 0.003) in mixed sports athletes, and 2.17 (1.41 to 3.32, P = 0.0003) in power sports athletes. The mean age at first admission to hospital was higher in endurance athletes (70.6) than in other groups (58.2 in mixed sports, 61.9 in power sports, and 61.2 in controls). Among the 2046 respondents to a questionnaire in 1985, the odds ratios for admission to hospital were similar in all three groups after adjusting for age, occupation, and body mass index at 20 (2.37, 2.42, 2.68). Athletes from all types of competitive sports are at slightly increased risk of requiring hospital care because of osteoarthritis of the hip, knee, or ankle. Mixed sports and power sports lead to increased admissions for premature osteoarthritis, but in endurance athletes the admissions are at an older age.
Article
Full-text available
Objectives: To update the EULAR recommendations for management of knee osteoarthritis (OA) by an evidence based medicine and expert opinion approach. Methods: The literature search and guidelines were restricted to treatments for knee OA pertaining to clinical and/or radiological OA of any compartment of the knee. Papers for combined treatment of knee and other types of OA were excluded. Medline and Embase were searched using a combination of subject headings and key words. Searches for those treatments previously investigated were conducted for January 1999 to February 2002 and for those treatments not previously investigated for 1966 to February 2002. The level of evidence found for each treatment was documented. Quality scores were determined for each paper, an effect size comparing the treatment with placebo was calculated, where possible, and a toxicity profile was determined for each treatment modality. Results: 497 new publications were identified by the search. Of these, 103 were intervention trials and included in the overall analysis, and 33 treatment modalities were identified. Previously identified publications which were not exclusively knee OA in the initial analysis were rejected. In total, 545 publications were included. Based on the results of the literature search and expert opinion, 10 recommendations for the treatment of knee OA were devised using a five stage Delphi technique. Based on expert opinion, a further set of 10 items was identified by a five stage Delphi technique as important for future research. Conclusion: The updated recommendations support some of the previous propositions published in 2000 but also include modified statements and new propositions. Although a large number of treatment options for knee OA exist, the evidence based format of the EULAR Recommendations continues to identify key clinical questions that currently are unanswered.
Article
AND CONCLUSIONS The dynamics of malalignment are based on the combination of the static limb alignment and the dynamics of loading at the knee during walking and other activities of daily living. Dynamic loading at the knee can be influenced by subconscious control of limb position such as foot placement, active muscle contraction, passive soft-tissue stability, as well as the speed of walking. The loads that are generated during these dynamic activities are substantially greater than the loads that can be generated during static postures. Therefore, limb alignment based on static radiographic measurements provides one component to the complete analysis of the factors influencing loading at the knee joint. Loading at the knee joint is an important consideration in the progression of degenerative processes at the knee, as well as in the planning and selection of certain treatment modalities. Dynamic malalignment that occurs during activities such as gait should be considered in evaluating the progression of disease processes as well as the selection of appropriate treatment modalities.
Article
▪ Objective: To evaluate the effect of weight loss in preventing symptomatic knee osteoarthritis in women. ▪ Design: Cohort analytic study. ▪ Setting: The Framingham Study, based on a sample of a defined population. ▪ Patients: Women who participated in the Framingham Knee Osteoarthritis Study (1983 to 1985): Sixty-four out of 796 women studied had recent-onset symptomatic knee osteoarthritis (knee symptoms plus radiographically confirmed osteoarthritis) were compared with women without disease. ▪ Measurements: Recalled date of symptom onset was used as the incident date of disease. Historical weight was defined as baseline body mass index up to 12 years before symptom onset. Change in body mass index was assessed at several intervals before the current examination. Odds ratios assessing the association between weight change and knee osteoarthritis were adjusted for age, baseline body mass index, history of previous knee injury, habitual physical activity level, occupational physical labor, smoking status, and attained education. ▪ Results: Weight change significantly affected the risk for the development of knee osteoarthritis. For example, a decrease in body mass index of 2 units or more (weight loss, approximately 5.1 kg) over the 10 years before the current examination decreased the odds for developing osteoarthritis by over 50% (odds ratio, 0.46; 95% Cl, 0.24 to 0.86; P = 0.02). Among those women with a high risk for osteoarthritis due to elevated baseline body mass index (> 25), weight loss also decreased the risk (for 2 units of body mass index, odds ratio, 0.41 ; P = 0.02). Weight gain was associated with a slightly increased risk for osteoarthritis, which was not statistically significant. ▪ Conclusion: Weight loss reduces the risk for symptomatic knee osteoarthritis in women.
Article
Zusammenfassung In einer Fall-Kontroll-Studie wurden die arbeitsbedingten Belastungen von 115 Männern und 86 Frauen mit einer röntgenologisch gesicherten Kniegelenksarthrose verglichen mit beschwerdefreien Kontrollpersonen (95 Männer, 87 Frauen). In einer altersstratifizierten Analyse wurden die geschlechtsspezifischen Odds Ratios (OR) berechnet. Danach war das Risiko für Männer, an einer Kniegelenksarthrose zu erkranken, erhöht bei einer knieenden Tätigkeit (OR 2.2), bei einer Teilkörpervibrationsbelastung (OR 2.8) und bei klimatischen Einwirkungen wie Nässe/Kälte/Zugluft (OR 2.0). Ferner hatten Männer in Metallberufen (OR 3.2) und in sonstigen gewerblichen Berufen (OR 3.1) ein erhöhtes Krankheitsrisiko. Das Risiko bei Frauen war erhöht bei einer stehenden Tätigkeit (OR 2.1) und bei dem Hantieren mit schwerem Werkzeug (OR 6.1).
Article
Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of sex and race. We found that obesity was associated with OA of the knee for each sex/race group (p < 0.01). The association was strongest for women, and it was present even for subjects without evidence of knee pain on physical examination. Frame size was not significantly associated with OA of the knee. Relative weight was weakly associated with OA of the hips in white women and nonwhite men but not significantly associated with OA of the sacroiliac joint. Diabetes did not seem to be an important risk factor for OA. These results suggest that the additional mechanical stress resulting from obesity is the principal reason for the association between obesity and OA.
Article
Objective Preventive strategies against knee osteoarthritis (OA) require a knowledge of risk factors that influence the initiation of the disorder and its subsequent progression. This population-based longitudinal study was performed to address this issue.Methods Ninety-nine men and 255 women aged ≥55 years had baseline interviews and weight-bearing knee radiographs in 1990–1991. Repeat radiographs were obtained in 1995–1996 (mean followup duration 5.1 years, median age at followup 75.8 years). Risk factors assessed at baseline were tested for their association with incident and progressive radiographic knee OA by logistic regression.ResultsRates of incidence and progression were 2.5% and 3.6% per year, respectively. After adjusting for age and sex, the risk of incident radiographic knee OA was significantly increased among subjects with higher baseline body mass index (odds ratio [OR] 18.3, 95% confidence interval [95% CI] 5.1–65.1, highest versus lowest third), previous knee injury (OR 4.8, 95% CI 1.0–24.1), and a history of regular sports participation (OR 3.2, 95% CI 1.1–9.1). Knee pain at baseline (OR 2.4, 95% CI 0.7–8.0) and Heberden's nodes (OR 2.0, 95% CI 0.7–5.7) were weakly associated with progression. Analyses based on individual radiographic features (osteophyte formation and joint space narrowing) supported differences in risk factors for either feature.Conclusion Most currently recognized risk factors for prevalent knee OA (obesity, knee injury, and physical activity) influence incidence more than radiographic progression. Furthermore, these factors might selectively influence osteophyte formation more than joint space narrowing. These findings are consistent with knee OA being initiated by joint injury, but with progression being a consequence of impaired intrinsic repair capacity.
Article
Objective. To estimate the risk of osteoarthritis (OA) of the hip and knee due to long-term weight-bearing sports activity in ex–elite athletes and the general population. Methods. A retrospective cohort study was conducted of 81 female ex–elite athletes (67 middle- and long-distance runners, and 14 tennis players), currently ages 40–65, recruited from original playing records, and 977 age-matched female controls, taken from the age–sex register of the offices of a group general practice in Chingford, Northeast London, England. The definition of OA included radiologic changes (joint space narrowing and osteophytosis) in the hip joints, patellofemoral (PF) joints, and tibiofemoral (TF) joints. Results. Compared with controls of similar age, the ex-athletes had greater rates of radiologic OA at all sites. This association increased further after adjustment for height and weight differences, and was strongest for the presence of osteophytes at the TF joints (odds ratio [OR] 3.57, 95% confidence interval [95% CI] 1.89–6.71), at the PF joints (OR 3.50, 95% CI 1.80–6.81), narrowing at the PF joints (OR 2.97, 95% CI 1.15–7.67), femoral osteophytes (OR 2.52, 95% CI 1.01–6.26), and hip joint narrowing (OR 1.60, 95% CI 0.73–3.48), and was weakest for narrowing at the TF joints (OR 1.17, 95% CI 0.71–1.94). No clear risk factors were seen within the ex-athlete groups, although the tennis players tended to have more osteophytes at the TF joints and hip, but the runners had more PF joint disease. Within the control group, a small subgroup of 22 women who reported long-term vigorous weight-bearing exercise had risks of OA similar to those of the ex-athletes. Ex-athletes had similar rates of symptom reporting but higher pain thresholds than controls, as measured by calibrated dolorimeter. Conclusion. Weight-bearing sports activity in women is associated with a 2–3-fold increased risk of radiologic OA (particularly the presence of osteophytes) of the knees and hips. The risk was similar in ex–elite athletes and in a subgroup from the general population who reported long-term sports activity, suggesting that duration rather than frequency of training is important.
Article
To evaluate the effect of weight loss in preventing symptomatic knee osteoarthritis in women. Cohort analytic study. The Framingham Study, based on a sample of a defined population. Women who participated in the Framingham Knee Osteoarthritis Study (1983 to 1985): Sixty-four out of 796 women studied had recent-onset symptomatic knee osteoarthritis (knee symptoms plus radiographically confirmed osteoarthritis) were compared with women without disease. Recalled date of symptom onset was used as the incident date of disease. Historical weight was defined as baseline body mass index up to 12 years before symptom onset. Change in body mass index was assessed at several intervals before the current examination. Odds ratios assessing the association between weight change and knee osteoarthritis were adjusted for age, baseline body mass index, history of previous knee injury, habitual physical activity level, occupational physical labor, smoking status, and attained education. Weight change significantly affected the risk for the development of knee osteoarthritis. For example, a decrease in body mass index of 2 units or more (weight loss, approximately 5,1 kg) over the 10 years before the current examination decreased the odds for developing osteoarthritis by over 50% (odds ratio, 0.46; 95% Cl, 0.24 to 0.86; P = 0.02). Among those women with a high risk for osteoarthritis due to elevated baseline body mass index (greater than or equal to 25), weight loss also decreased the risk (for 2 units of body mass index, odds ratio, 0.41; P = 0.02). Weight gain was associated with a slightly increased risk for osteoarthritis, which was not statistically significant. Weight loss reduces the risk for symptomatic knee osteoarthritis in women.
Article
The gait of normal subjects and patients with varus deformities at the knee was studied by analyzing the interaction between the dynamic (muscular) and passive (ligamentous) restraints affecting lateral stability of the knee. A statistically determinant model predicted that the midstance-phase adducting moment during normal gait would cause lateral knee joint opening if either antagonistic muscle force and/or pretension in the lateral soft tissues were not present at the knee. The patient group tended to compensate for a high midstance-phase adducting moment by walking with a style of gait that demanded more muscle force (greater flexion-extension moments). This walking style reduced the chance of lateral joint opening. It can be speculated that this style of gait would help to maintain equilibrium at the knee. The higher muscle force would aid in resisting the adducting moment, keeping the joint closed laterally and thus increasing the stability of the knee.
Article
The Framingham Knee Osteoarthritis study is a population-based study of independently living elderly examining the prevalence of radiographic and symptomatic knee osteoarthritis. This group was assessed in the early 1980s at which time they had been observed for over 35 years and many risk factors for osteoarthritis had been ascertained. Results from this study suggest that knee osteoarthritis increases in prevalence throughout the elderly years, more so in women than in men. Also, studies of risk factors have shown that obesity precedes and increases the risk of knee osteoarthritis, especially in women. Other risk factors documented by the Framingham Osteoarthritis study to be important as risk factors for disease include knee injury, chondrocalcinosis, and occupational knee bending and physical labor. Radiographic knee osteoarthritis was negatively associated with smoking. No clearcut relationship of osteoarthritis with estrogen use in women was found. In terms of disability, lower extremity dysfunction is common in patients with knee osteoarthritis, but upper extremity dysfunction is not, and symptoms and severe degrees of radiographic osteoarthritis are associated with higher risks of dysfunction.
Article
The importance of systemic/metabolic factors in the association of obesity with radiographic knee osteoarthritis (OA) was examined for 3,905 adults aged 45 to 74 from the United States National Health and Nutrition Examination Survey, 1971 to 1975 (NHANES I). Obesity was associated with both bilateral and unilateral OA, but more strongly with bilateral OA. Obesity was also associated with both symptomatic and nonsymptomatic knee OA. Controlling for age, sex, serum cholesterol, serum uric acid, diabetes, body fat distribution, bone density, and blood pressure did not significantly reduce the association between obesity and knee OA. Findings from these data are not supportive of a metabolic link between obesity and knee OA.
Article
Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.
Article
To determine whether obesity preceded knee osteoarthritis and was thus a possible cause. Cohort study with weight and other important variables measured in 1948 to 1951 (mean age of subjects, 37 years) and knee arthritis evaluated in 1983 to 1985 (mean age of subjects, 73 years). Population-based participants; a subset (n = 1420) of the Framingham Heart Study cohort. For those subjects in the Framingham Study having knee radiographs taken as part of the 18th biennial examination (1983 to 1985), we examined Metropolitan Relative Weight, a measure of weight adjusted for height at the onset of the study (1948 to 1951). Relative risks were computed as the cumulative incidence rate of radiographic knee osteoarthritis in the heaviest weight groups at examination 1 divided by the cumulative rate in the lightest 60% weight groups at examination 1. Relative risks were adjusted for age, physical activity level, and uric acid level. In 1983 to 1985, 468 subjects (33%) had radiographic knee osteoarthritis. For men, the risk of knee osteoarthritis was increased in those in the heaviest quintile of weight at examination 1 compared with those in the lightest three quintiles (age-adjusted relative risk, 1.51; 95% confidence interval [CI], 1.14 to 1.98); risk was not increased for those in the second heaviest quintile (relative risk, 1.0). The association between weight and knee osteoarthritis was stronger in women than in men; for women in the most overweight quintile at examination 1, relative risk was 2.07 (95% CI, 1.67 to 2.55), and for those in the second heaviest group, relative risk was 1.44 (95% CI, 1.11 to 1.86). This link between obesity and subsequent osteoarthritis persisted after controlling for serum uric acid level and physical activity level, and was strongest for persons with severest radiographic disease. Obesity at examination 1 was associated with the risk of developing both symptomatic and asymptomatic osteoarthritis. These results and other corroborative cross-sectional data show that obesity or as yet unknown factors associated with obesity cause knee osteoarthritis.
Article
To examine the association of body weight, body fatness, and body fat distribution with osteoarthritis (OA) of the knee. Bilateral standing knee radiographs, taken between 1985 and 1991, of 465 Caucasian men and 275 Caucasian women subjects aged 40 and above in the Baltimore Longitudinal Study of Aging were read by one investigator for grade of OA using Kellgren-Lawrence scales. Measures of obesity, assessed at same visit as the last radiograph during this interval, included body mass index, percent body fat, and body fat distribution. Both men and women with definite knee OA had higher age adjusted mean levels of body mass index, while women only had higher age adjusted mean levels of percent body fat. Both women and men in the highest tertile of body mass index had significantly increased odds of both definite and bilateral knee OA; women in the middle and highest tertile of percent body fat had significantly increased odds of both definite and bilateral knee OA, and men in the highest tertile of waist-hip ratio had significantly increased odds of bilateral knee OA. After adjusting for body mass index, however, the association of percent body fat and waist-hip ratio with knee OA in women and men, respectively, was no longer significant. These data further extend observations that body weight is associated with both definite and bilateral knee OA in both sexes, and support a stronger contribution of mechanical as opposed to systemic factors to explain this association.
Article
The purpose of our study was to determine the effects of severe obesity on the foot mechanics of adult females. Twenty-nine adult females between the ages of 20 and 48 years volunteered as subjects for this investigation. The subjects were separated into a severely obese (O) group (body mass index = 41.14 +/- 2.61; N = 16) and a normal weight control group (body mass index = 20.84 +/- 0.47; N = 13). A Locam camera (100 Hz) positioned perpendicular to the subjects' posterior aspect was used to film the rearfoot movement of the subjects during the final 15 sec of a 10 min treadmill walk. The O group had a significantly greater touchdown angle (P = .05), more total eversion range of motion (P = .001), and a faster maximum eversion velocity (P < .001). Moreover, analysis of dynamic foot angles indicated that the O group had significantly (P = .003) more forefoot abduction. Finally, anthropometric data revealed statistically different (P < .001) Q angle measurements between the O and control groups. The results of this study suggest that severely obese females have significantly greater rearfoot motion, foot angle, and Q angle values than normal weight females.
Article
The dynamics of malalignment are based on the combination of the static limb alignment and the dynamics of loading at the knee during walking and other activities of daily living. Dynamic loading at the knee can be influenced by subconscious control of limb position such as foot placement, active muscle contraction, passive soft-tissue stability, as well as the speed of walking. The loads that are generated during these dynamic activities are substantially greater than the loads that can be generated during static postures. Therefore, limb alignment based on static radiographic measurements provides one component to the complete analysis of the factors influencing loading at the knee joint. Loading at the knee joint is an important consideration in the progression of degenerative processes at the knee, as well as in the planning and selection of certain treatment modalities. Dynamic malalignment that occurs during activities such as gait should be considered in evaluating the progression of disease processes as well as the selection of appropriate treatment modalities.
Article
A common question posed to rheumatologists by both patients and physicians is 'What is the role of exercise in arthritis?' Practitioners and patients want to know if regular exercise is a risk factor for the later development of osteoarthritis. This article briefly reviews the epidemiology of osteoarthritis and exercise and risk factors associated with the development of osteoarthritis in athletes. It also reviews how musculoskeletal tissues respond to loading in normal and injured states. Finally, the topic of exercise for arthritic patients is reviewed, and recommendations are given.
Article
Occupational risk factors for arthrosis of the knee confirmed by x-ray were evaluated in a case-control study comprising 115 male and 86 females cases. Controls (95 men and 87 women) were free of symptoms of the musculoskeletal system. For both sexes age-adjusted odds ratios were calculated. Elevated odds rations were found in men working on their knees (OR 2.2), being exposed to vibrations of the upper limbs (OR 2.8), or adverse climatic conditions--humidity, coldness, or current air (OR 2.0). Men working in the metal industry or in other not further classified blue collar jobs also showed increased odds ratios (OR 3.2 and 3.1). In women odds rations were elevated for working in a standing position (OR 2.1) and for working with heavy tools (OR 6.1).
Article
A three-dimensional model of the lower limb containing 47 muscles was developed to study the differences between a two- and three-dimensional approach for determining internal loads, the role of the dynamic joint representation, and the behavior of different load-bearing criteria in walking and running. The problem of redundancy of the musculo-skeletal system was resolved by applying inverse dynamics and static optimization methods. Different hypothetical load-bearing capabilities of hinge, spherical and intermediate joint types for the knee and the ankle joints were tested. It was found that even almost planar movements such as walking and running are associated with significant three-dimensional intersegment moments, especially in the frontal plane. Thus, a two-dimensional approach may underestimate internal loads up to 60%. It is shown that pure hinge joints are inappropriate for modeling the dynamical joint function of the knee and ankle joints. A more flexible joint representation in combination with a squared muscle stress minimization criterion predicted a lot of synergistic as well as antagonistic muscle activation which was also found in the EMG patterns. The results indicate the importance of muscular joint stabilization in natural human movements. Compared to in vivo measurements it is speculated that the predicted force magnitudes are considerably overestimated due to error propagation and still insufficient anatomical models. Thus, increased efforts to improve further the reliability of internal load calculations should be made in the future.
Article
The relation of exercise to osteoarthritis is one of great interest and importance. In this paper, we review two recent studies. One reported that older individuals with normal knee and hip joints who jog for recreational activities do not have an increased risk for the development of osteoarthritis in weight-bearing joints. However, in another case-control study of women with hip osteoarthritis, the risk of hip osteoarthritis increased twofold with high levels of participation in recreational activities before the age of 50 years and fourfold for women with high levels of sporting activities and occupational physical loads. Therefore, participation in certain types of sporting activities and occupations that increase loading to the hip joint before the age of 50 years may be associated with an increased risk of hip osteoarthritis. However, recreational jogging in individuals 60 or more years of age with normal knee and hip joints does not increase the risk for the development of osteoarthritis. These studies add to our knowledge base regarding lifetime and current risk factors for the development of knee and hip osteoarthritis from exercise.
Article
The objective of this study was to assess the association between obesity and osteoarthritis (OA) of the knee, hip, and hand. OA patterns were studied in 809 patients with knee or hip joint replacement due to OA. Patients with OA were categorized as having bilateral or generalized OA according to the presence of radiographic OA in the contralateral joint or different finger joints, and as normal weight, overweight, or obese according to their body mass index (BMI). Odds ratios (OR) and 95% confidence intervals (CI) for relative weight and OA patterns were estimated with multivariable logistic regression. Eighty-five percent of participants had bilateral OA, 26% had generalized OA, and 31% were obese. Obesity (BMI >/= 30 kg/m(2); OR = 8.1; 95% CI: 2.4-28) and overweight (BMI >/= 25 kg/m(2); OR = 5.9; 95% CI: 2.0-18) were strongly associated with bilateral knee OA. No association between obesity and bilateral hip OA (OR = 0.7; 95% CI: 0.3-1.7) nor generalized OA (OR = 1.1; 95% CI: 0.6-2.1) was observed. Obesity seems to be a mechanical rather than a systemic risk factor for OA with the knee joint being especially susceptible.
Article
Osteoarthritis (OA) of the knee leads to restrictions of physical activity and ability to perform activities of daily living. Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability. The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was developed to test the efficacy of lifestyle behavioral changes on physical function, pain, and disability in obese, sedentary older adults with knee OA. This controlled trial randomized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups: Healthy Lifestyle Control; Dietary Weight Loss; Structured Exercise; or Combined Exercise and Dietary Weight Loss. The weight-loss goal for the diet groups was a 5% loss at 18 months. The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory. Exercise training consisted of aerobic and strength training for 60 minutes, three times per week in a group and home-based setting. The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index. Other measurements included timed stair climb, distance walked in 6 minutes, strength, gait, knee pain, health-related quality of life, knee radiographs, body weight, dietary intake, and cost-effectiveness of the interventions. We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks. The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA.
Article
While it is widely speculated that obesity causes increased loads on the knee leading to joint degeneration, this concept is untested. The purpose of the study was to identify the effects of obesity on lower extremity joint kinetics and energetics during walking. Twenty-one obese adults were tested at self-selected (1.29m/s) and standard speeds (1.50m/s) and 18 lean adults were tested at the standard speed. Motion analysis and force platform data were combined to calculate joint torques and powers during the stance phase of walking. Obese participants were more erect with 12% less knee flexion and 11% more ankle plantarflexion in self-selected compared to standard speeds (both p<0.02). Obese participants were still more erect than lean adults with approximately 6 degrees more extension at all joints (p<0.05, for each joint) at the standard speed. Knee and ankle torques were 17% and 11% higher (p<0.034 and p<0.041) and negative knee work and positive ankle work were 68% and 11% higher (p<0.000 and p<0.048) in obese participants at the standard speed compared to the slower speed. Joint torques and powers were statistically identical at the hip and knee but were 88% and 61% higher (both p<0.000) at the ankle in obese compared to lean participants at the standard speed. Obese participants used altered gait biomechanics and despite their greater weight, they had less knee torque and power at their self-selected walking speed and equal knee torque and power while walking at the same speed as lean individuals. We propose that the ability to reorganize neuromuscular function during gait may enable some obese individuals to maintain skeletal health of the knee joint and this ability may also be a more accurate risk indicator for knee osteoarthritis than body weight.
Article
The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was a randomized, single-blind clinical trial lasting 18 months that was designed to determine whether long-term exercise and dietary weight loss are more effective, either separately or in combination, than usual care in improving physical function, pain, and mobility in older overweight and obese adults with knee osteoarthritis (OA). Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older, with a body mass index of > or =28 kg/m(2), knee pain, radiographic evidence of knee OA, and self-reported physical disability, were randomized into healthy lifestyle (control), diet only, exercise only, and diet plus exercise groups. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included weight loss, 6-minute walk distance, stair-climb time, WOMAC pain and stiffness scores, and joint space width. Of the 316 randomized participants, 252 (80%) completed the study. Adherence was as follows: for healthy lifestyle, 73%; for diet only, 72%; for exercise only, 60%; and for diet plus exercise, 64%. In the diet plus exercise group, significant improvements in self-reported physical function (P < 0.05), 6-minute walk distance (P < 0.05), stair-climb time (P < 0.05), and knee pain (P < 0.05) relative to the healthy lifestyle group were observed. In the exercise group, a significant improvement in the 6-minute walk distance (P < 0.05) was observed. The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures. The weight-loss groups lost significantly (P < 0.05) more body weight (for diet, 4.9%; for diet plus exercise, 5.7%) than did the healthy lifestyle group (1.2%). Finally, changes in joint space width were not different between the groups. The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone.
Article
To compare the gait of older adults with knee osteoarthritis (OA) to an age-, sex-, and weight-matched healthy cohort that would provide preliminary data to examine the hypothesis that adults with knee OA have abnormal knee joint moments and place greater loads on the knee joint during walking compared with healthy adults. Nonrandomized, descriptive stu