Advertisement

Are biomechanics during gait associated with the structural disease onset and progression of lower limb osteoarthritis? A systematic review and meta-analysis

Published:October 28, 2021DOI:https://doi.org/10.1016/j.joca.2021.10.010

      Summary

      Objective

      To evaluate if gait biomechanics are associated with increased risk of structurally diagnosed disease onset or progression of lower limb osteoarthritis (OA).

      Method

      A systematic review of Medline and Embase was conducted from inception to July 2021. Two reviewers independently screened records, extracted data and assessed risk of bias. Included studies reported gait biomechanics at baseline, and either structural imaging or joint replacement occurrence in the lower limb at follow-up. The primary outcome was the Odds Ratio (OR) (95% confidence interval (CI)) of the association between biomechanics and structural OA outcomes with data pooled for meta-analysis.

      Results

      Twenty-three studies reporting 25 different biomechanical metrics and 11 OA imaging outcomes were included (quality scores ranged 12–20/21). Twenty studies investigated knee OA progression; three studies investigated knee OA onset. Two studies investigated hip OA progression. 91% of studies reported a significant association between at least one biomechanical variable and OA onset or progression. There was an association between frontal plane biomechanics with medial tibiofemoral and hip OA progression and sagittal plane biomechanics with patellofemoral OA progression. Meta-analyses demonstrated increased odds of medial tibiofemoral OA progression with greater baseline peak knee adduction moment (KAM) (OR: 1.88 [95%CI: 1.08, 3.29]) and varus thrust presence (OR: 1.97 [95%CI: 1.32, 2.96]).

      Conclusion

      Evidence suggests that certain gait biomechanics are associated with an increased odds of OA onset and progression in the knee, and progression in the hip.

      Registration number

      PROSPERO CRD42019133920

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Osteoarthritis and Cartilage
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hunter D.J.
        Osteoarthritis.
        Best Pract Res Clin Rheumatol. 2011; 25: 801-814
        • Vos T.
        • Barber R.M.
        • Bell B.
        • Bertozzi-Villa A.
        • Biryukov S.
        • Bolliger I.
        • et al.
        Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2015; 386: 743-800
        • Kingsbury S.R.
        • Gross H.J.
        • Isherwood G.
        • Conaghan P.G.
        Osteoarthritis in Europe: impact on health status, work productivity and use of pharmacotherapies in five European countries.
        Rheumatology. 2014; 53: 937-947
        • Andriacchi T.
        • Mündermann A.
        • Smith R.
        • Alexander E.
        • Dyrby C.
        • Koo S.
        A framework for the in vivo pathomechanics of osteoarthritis at the knee.
        Ann Biomed Eng. 2004; 32: 447-457
        • Ko F.C.
        • Dragomir C.
        • Plumb D.A.
        • Goldring S.R.
        • Wright T.M.
        • Goldring M.B.
        • van der Meulen M.C.
        In vivo cyclic compression causes cartilage degeneration and subchondral bone changes in mouse tibiae.
        Arthritis Rheum. 2013; 65: 1569-1578
        • Stewart H.L.
        • Kawcak C.E.
        The importance of subchondral bone in the pathophysiology of osteoarthritis.
        Frontiers In Veterinary Science. 2018; 5: 178
        • Simon S.R.
        • Radin E.L.
        • Paul I.L.
        • Rose R.M.
        The response of joints to impact loading — II in vivo behavior of subchondral bone.
        J Biomech. 1972; 5: 267-272
        • Lee M.S.
        • Trindade M.C.D.
        • Ikenoue T.
        • Schurman D.J.
        • Goodman S.B.
        • Smith R.L.
        Effects of shear stress on nitric oxide and matrix protein gene expression in human osteoarthritic chondrocytes in vitro.
        J Orthop Res. 2002; 20: 556-561
        • Favre J.
        • Jolles B.M.
        Gait analysis of patients with knee osteoarthritis highlights a pathological mechanical pathway and provides a basis for therapeutic interventions.
        EFORT Open Reviews. 2016; 1: 368-374
        • Cappozzo A.
        • Della Croce U.
        • Leardini A.
        • Chiari L.
        Human movement analysis using stereophotogrammetry: Part 1: theoretical background.
        Gait Posture. 2005; 21: 186-196
        • Kutzner I.
        • Trepczynski A.
        • Heller M.O.
        • Bergmann G.
        Knee adduction moment and medial contact force--facts about their correlation during gait.
        PLoS One. 2013; 8: 81036
        • Birmingham T.
        • Hunt M.
        • Jones I.
        • Jenkyn T.
        • Giffin J.
        Test-retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis.
        Arthritis Care Res. 2007; 57: 1012-1017
        • Bennell K.L.
        • Bowles K.-A.
        • Wang Y.
        • Cicuttini F.
        • Davies-Tuck M.
        • Hinman R.S.
        Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis.
        Ann Rheum Dis. 2011; 70: 1770-1774
        • Miyazaki T.
        • Wada M.
        • Kawahara H.
        • Sato M.
        • Baba H.
        • Shimada S.
        Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis.
        Ann Rheum Dis. 2002; 61: 617-61722
        • Tateuchi H.
        • Koyama Y.
        • Akiyama H.
        • Goto K.
        • So K.
        • Kuroda Y.
        • et al.
        Daily cumulative hip moment is associated with radiographic progression of secondary hip osteoarthritis.
        Osteoarthritis Cartilage. 2017; 25: 1291-1298
        • Queen R.
        Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty.
        J Orthop Res. 2017; 35: 2345-2355
        • Henriksen M.
        • Creaby M.W.
        • Lund H.
        • Juhl C.
        • Christensen R.
        Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials.
        BMJ Open. 2014; 4005368
        • Davis E.M.
        • Hubley-Kozey C.L.
        • Landry S.C.
        • Ikeda D.M.
        • Stanish W.D.
        • Astephen Wilson J.L.
        Longitudinal evidence links joint level mechanics and muscle activation patterns to 3-year medial joint space narrowing.
        Clin BioMech. 2019; 61: 233-239
        • Chang A.H.
        • Moisio K.C.
        • Chmiel J.S.
        • Eckstein F.
        • Guermazi A.
        • Prasad P.V.
        • et al.
        External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis.
        Osteoarthritis Cartilage. 2015; 23: 1099-1106
        • Creaby M.W.
        It's not all about the knee adduction moment: the role of the knee flexion moment in medial knee joint loading.
        Osteoarthritis Cartilage. 2015; 23: 1038-1040
        • Wink A.E.
        • Gross K.D.
        • Brown C.A.
        • Guermazi A.
        • Roemer F.
        • Niu J.
        • et al.
        Varus thrust during walking and the risk of incident and worsening medial tibiofemoral MRI lesions: the Multicenter Osteoarthritis Study.
        Osteoarthritis Cartilage. 2017; 25: 839-845
        • Bowling F.L.
        • Reeves N.D.
        Conservative biomechanical strategies for knee osteoarthritis.
        Nat Rev Rheumatol. 2011; 7: 113-122
        • Jones R.K.
        • Nester C.J.
        • Richards J.D.
        • Kim W.Y.
        • Johnson D.S.
        • Jari S.
        • et al.
        A comparison of the biomechanical effects of valgus knee braces and lateral wedged insoles in patients with knee osteoarthritis.
        Gait Posture. 2012; 37: 368-372
        • Maly M.R.
        • Culham E.G.
        • Costigan P.A.
        Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis.
        Clin BioMech. 2002; 17: 603-610
        • Simic M.
        • Bennell K.L.
        • Hunt M.A.
        • Wrigley T.V.
        • Hinman R.S.
        Contralateral cane use and knee joint load in people with medial knee osteoarthritis: the effect of varying body weight support.
        Osteoarthritis Cartilage. 2011; 19: 1330-1337
        • Simic M.
        • Hinman R.S.
        • Wrigley T.V.
        • Bennell K.L.
        • Hunt M.A.
        Gait modification strategies for altering medial knee joint load: a systematic review.
        Arthritis Care Res. 2011; 63: 405-426
        • Bruyere O.
        • Richy F.
        • Reginster J.Y.
        Three year joint space narrowing predicts long term incidence of knee surgery in patients with osteoarthritis: an eight year prospective follow up study.
        Ann Rheum Dis. 2005; 64: 1727-1730
        • Tanamas S.K.
        • Wluka A.E.
        • Pelletier J.-P.
        • Pelletier J.M.
        • Abram F.
        • Berry P.A.
        • et al.
        Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal study.
        Rheumatology. 2010; 49: 2413-2419
        • Chapple C.M.
        • Nicholson H.
        • Baxter G.D.
        • Abbott J.H.
        Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies.
        Arthritis Care Res. 2011; 63: 1115-1125
        • Foroutan F.
        • Guyatt G.
        • Zuk V.
        • Vandvik P.O.
        • Alba A.C.
        • Mustafa R.
        • et al.
        GRADE Guidelines 28: use of GRADE for the assessment of evidence about prognostic factors: rating certainty in identification of groups of patients with different absolute risks.
        J Clin Epidemiol. 2020; 121: 62-70
        • Rohatgi A.
        WebPlotDigitizer.
        2020
        • Higgins J.P.T.
        Cochrane Handbook for Systematic Reviews of Interventions. 2nd edn. Wiley-Blackwell, Hoboken, NJ2019
        • Teng H.-L.
        • Macleod T.D.
        • Link T.M.
        • Majumdar S.
        • Souza R.B.
        Higher knee flexion moment during the second half of the stance phase of gait is associated with the progression of osteoarthritis of the patellofemoral joint on magnetic resonance imaging.
        J Orthop Sports Phys Ther. 2015; 45: 656-664
        • Brisson N.M.
        • Wiebenga E.G.
        • Stratford P.W.
        • Beattie K.A.
        • Totterman S.
        • Tamez-Peña J.G.
        • et al.
        Baseline knee adduction moment interacts with body mass index to predict loss of medial tibial cartilage volume over 2.5 years in knee Osteoarthritis.
        J Orthop Res. 2017; 35: 2476-2483
        • Chang A.H.
        • Chmiel J.S.
        • Almagor O.
        • Guermazi A.
        • Prasad P.V.
        • Moisio K.C.
        • et al.
        Association of baseline knee sagittal dynamic joint stiffness during gait and 2-year patellofemoral cartilage damage worsening in knee osteoarthritis.
        Osteoarthritis Cartilage. 2017; 25: 242-248
        • Chang A.
        • Hayes K.
        • Dunlop D.
        • Hurwitz D.
        • Song J.
        • Cahue S.
        • et al.
        Thrust during ambulation and the progression of knee osteoarthritis.
        Arthritis Rheum. 2004; 50: 3897-3903
        • Chang A.
        • Hayes K.
        • Dunlop D.
        • Song J.
        • Hurwitz D.
        • Cahue S.
        • et al.
        Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression.
        Arthritis Rheum. 2005; 52: 3515-3519
        • Chang A.
        • Hurwitz D.
        • Dunlop D.
        • Song J.
        • Cahue S.
        • Hayes K.
        • et al.
        The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis.
        Ann Rheum Dis. 2007; 66: 1271-1275
        • Chehab E.F.
        • Favre J.
        • Erhart-Hledik J.C.
        • Andriacchi T.P.
        Baseline knee adduction and flexion moments during walking are both associated with 5 year cartilage changes in patients with medial knee osteoarthritis.
        Osteoarthritis Cartilage. 2014; 22: 1833-1839
        • Favre J.
        • Erhart-Hledik J.C.
        • Chehab E.F.
        • Andriacchi T.P.
        Baseline ambulatory knee kinematics are associated with changes in cartilage thickness in osteoarthritic patients over 5 years.
        J Biomech. 2016; 49: 1859-1864
        • Hatfield G.L.
        • Stanish W.D.
        • Hubley-Kozey C.L.
        Three-dimensional biomechanical gait characteristics at baseline are associated with progression to total knee arthroplasty.
        Arthritis Care Res. 2015; 67: 1004-1014
        • Sharma L.
        • Chang A.H.
        • Jackson R.D.
        • Nevitt M.
        • Moisio K.C.
        • Hochberg M.
        • et al.
        Varus thrust and incident and progressive knee osteoarthritis.
        Arthritis & Rheumatology. 2017; 69: 2136-2143
        • Stefanik J.J.
        • Gross K.D.
        • Guermazi A.
        • Felson D.T.
        • Roemer F.W.
        • Niu J.
        • et al.
        Relation of step length to magnetic resonance imaging–detected structural damage in the patellofemoral joint: the multicenter osteoarthritis study.
        Arthritis Care Res. 2016; 68: 776-783
        • Costello K.E.
        • Astephen Wilson J.L.
        • Stanish W.D.
        • Urquhart N.
        • Hubley-Kozey C.L.
        Differences in baseline joint moments and muscle activation patterns associated with knee osteoarthritis progression when defined using a clinical versus a structural outcome.
        J Appl Biomech. 2020; 36: 1-51
        • Hart H.F.
        • Gross K.D.
        • Crossley K.M.
        • Barton C.J.
        • Felson D.T.
        • Guermazi A.
        • et al.
        Step rate and worsening of patellofemoral and tibiofemoral joint osteoarthritis in women and men: the multicenter osteoarthritis study.
        Arthritis Care Res. 2020; 72: 107-113
        • Mahmoudian A.
        • van Dien J.H.
        • Bruijn S.M.
        • Baert I.A.C.
        • Faber G.S.
        • Luyten F.P.
        • et al.
        Dynamic and static knee alignment at baseline predict structural abnormalities on MRI associated with medial compartment knee osteoarthritis after 2 years.
        Gait Posture. 2017; 57: 46-51
        • Erhart-Hledik J.C.
        • Chehab E.F.
        • Asay J.L.
        • Favre J.
        • Chu C.R.
        • Andriacchi T.P.
        Longitudinal changes in tibial and femoral cartilage thickness are associated with baseline ambulatory kinetics and cartilage oligomeric matrix protein (COMP) measures in an asymptomatic aging population.
        Osteoarthritis Cartilage. 2021; 29: 687-696
        • Brisson N.M.
        • Gatti A.A.
        • Damm P.
        • Duda G.N.
        • Maly M.R.
        Association of machine learning based predictions of medial knee contact force with cartilage loss over 2.5 years in knee osteoarthritis.
        Arthritis & Rheumatology. 2021; 73: 1638-1645
        • Kumar D.
        • Wyatt C.
        • Lee S.
        • Okazaki N.
        • Chiba K.
        • Link T.M.
        • et al.
        Sagittal plane walking patterns are related to MRI changes over 18-months in people with and without mild-moderate hip osteoarthritis.
        J Orthop Res. 2018; 36: 1472-1477
        • Simic M.
        • Hunt M.A.
        • Bennell K.L.
        • Hinman R.S.
        • Wrigley T.V.
        Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: the effect of varying trunk lean angles.
        Arthritis Care Res. 2012; 64: 1545-1553
        • Woollard J.D.
        • Gil A.B.
        • Sparto P.
        • Kwoh C.K.
        • Piva S.R.
        • Farrokhi S.
        • et al.
        Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis.
        J Orthop Sports Phys Ther. 2011; 41: 708-722
        • Trepczynski A.
        • Kutzner I.
        • Bergmann G.
        • Taylor W.R.
        • Heller M.O.
        Modulation of the relationship between external knee adduction moments and medial joint contact forces across subjects and activities.
        Arthritis & Rheumatology. 2014; 66: 1218-1227
        • Issa S.
        • Sharma L.
        Epidemiology of osteoarthritis: an update.
        Curr Rheumatol Rep. 2006; 8: 7-15
        • Loudon J.K.
        Biomechanics and pathomechanics of the patellofemoral joint.
        Int J Sports Phys Ther. 2016; 11: 820-830
        • Kobayashi S.
        • Pappas E.
        • Fransen M.
        • Refshauge K.
        • Simic M.
        The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis.
        Osteoarthritis Cartilage. 2016; 24: 1697-1707
        • Tateuchi H.
        • Koyama Y.
        • Tsukagoshi R.
        • Akiyama H.
        • Goto K.
        • So K.
        • et al.
        Associations of radiographic degeneration and pain with daily cumulative hip loading in patients with secondary hip osteoarthritis.
        J Orthop Res. 2016; 34: 1977-1983