Gait Differs Between Unilateral and Bilateral Knee Osteoarthritis

doi:10.1016/j.apmr.2011.11.029

Archives of Physical Medicine and Rehabilitation

Volume 93, Issue 5, May 2012, Pages 822-827

https://doi.org/10.1016/j.apmr.2011.11.029 Get rights and content

Abstract

Creaby MW, Bennell KL, Hunt MA. Gait differs between unilateral and bilateral knee osteoarthritis.

Objectives

To compare walking biomechanics in the most painful leg, and symmetry in biomechanics between legs, in individuals with (1) unilateral pain and structural osteoarthritis (OA), (2) unilateral pain, but bilateral structural OA, and (3) bilateral pain and structural OA and in (4) an asymptomatic control group.

Design

Cohort study.

Setting

Laboratory based.

Participants

Participants with symptomatic and/or radiographic medial tibiofemoral OA in one or both knees (n=91), and asymptomatic control participants (n=31).

Interventions

Not applicable.

Main Outcome Measure

The peak knee adduction moment, peak knee flexion moment, knee varus-valgus angle, peak knee flexion angle, toe-out, and trunk lean were computed from 3-dimensional analysis of walking at a self-selected speed.

Results

After controlling for walking speed, greater trunk lean toward the more painful knee and reduced flexion in the more painful knee were observed in all OA groups compared with the control group. Between-knee asymmetries indicating greater varus angle and a lower external flexion moment in the painful knee were present in those with unilateral pain and either unilateral or bilateral structural OA. Knee biomechanics were symmetrical in those with bilateral pain and structural OA and in the pain free control group.

Conclusions

The presence of pain unilaterally appears to be associated with asymmetries in knee biomechanics. Contrary to this, bilateral pain is associated with symmetry. This suggests that the symptomatic status of both knees should be considered when contemplating unilateral or bilateral biomechanical interventions for medial knee OA.

Section snippets

Participants

One hundred twenty-two participants, including 91 with medial compartment knee OA and 31 asymptomatic, healthy controls, were recruited from the local community. Participants in the OA groups were originally recruited for a randomized controlled trial of hip strengthening,²³ and the measurements included in this study were taken at baseline prior to intervention. Inclusion criteria for the OA participants were as follows: age over 50 years, knee pain on most days of the previous month (average

Results

Participant characteristics, stratified by group, are shown in table 1. Of the 91 participants with knee OA, 11 were classified as Uni-pain/Uni-xray, 22 were classified as Uni-pain/Bi-xray, and 56 as Bi-pain/Bi-xray. Two knee OA participants had bilateral pain but unilateral evidence of knee OA on radiograph and were not considered in our analysis. Groups were similar in age, height, and sex distribution. The Uni-pain/Uni-xray group had a significantly higher body mass index than the other 3

Discussion

Our data illustrate that between-limb asymmetries in gait were principally limited to individuals with unilateral knee pain, and either unilateral or bilateral structural disease, whereas relative symmetry in gait is apparent in those with bilateral pain and in asymptomatic individuals. These findings may have important implications regarding the tailoring of gait intervention strategies on the basis of the symptomatic and structural status of both knees in individuals presenting with medial

Conclusions

Our data indicate that individuals with unilateral knee pain and either unilateral or bilateral structural medial knee OA demonstrate asymmetries in knee biomechanics during walking in the frontal (knee varus angle) and sagittal (peak flexion moment) planes. Contrary to this, individuals with bilateral pain and structural disease exhibited symmetrical biomechanics at the knee during walking. Thus, interventions addressing the underlying biomechanics of knee OA may be best applied to both knees

Acknowledgments

We thank Fiona McManus, BPhysio(Hons), for assisting with participant recruitment and data collection.

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Citation Excerpt :
Most scores were able to differentiate between healthy adults and both A-OA and ACLR patients with medium to large effect sizes, although predictive capability varied. Differences in gait symmetry between healthy adults and A-OA patients observed in the current study align well with findings in prior literature (Creaby et al., 2012; Mills et al., 2013; Schmitt et al., 2015; Valderrabano et al., 2007). Similarly, landing asymmetries reflected in prior literature between healthy athletes and ACLR patients align well with those observed in the current study (Paterno et al., 2007; Peebles et al., 2021; Schmitt et al., 2015).
Decreased movement symmetry is associated with injury risk and accelerated disease progression. Methods to analyze continuous data either cannot be used in pathologic populations with abnormal movement patterns or are not defined in terms easily incorporated into clinical care. The purpose of this study was to develop a method of describing symmetry and movement quality in continuous time-series data that results in scores that can be readily incorporated into clinical care. Two scores were developed: (1) the symmetry score (SS) which evaluates similarities in time-series data between limbs and (2) the closeness-to-healthy score (CTHS) which evaluates the similarity of time-series data to a control population. Kinetic and kinematic data from 56 end-stage unilateral ankle arthritis (A-OA) patients and 56 healthy older adults, along with 16 anterior cruciate ligament reconstruction (ACLR) patients and 16 healthy young adults were used to test the ability for SS and CTHS to differentiate between healthy and patient groups. Unpaired t-tests, Cohen’s D effect sizes, and receiver-operating-curve analyses assessed group differences [SPSS, V27, α = 0.05]. Patients had worse SS than controls and A-OA patients had worse CTHS compared to controls. SS had strong predictive capability, while the predictive capability of CTHS varied. Combined with clinically accessible data collection methods, the SS and CTHS could be used to evaluate patients’ baseline movement quality, assess changes due to disease progression, and during recovery. Results could be utilized in clinical decision making to assess surgical intervention urgency and efficacy of surgical interventions or rehabilitation protocols to improve side-to-side limb symmetry.

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: Reprints are not available from the author.

: Supported by the National Health and Medical Research Council, Australia (project grant no. 454686); and an Australian Research Council Future Fellowship.

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: In-press corrected proof published online on Mar 5, 2012, at www.archives-pmr.org.

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Original articleGait Differs Between Unilateral and Bilateral Knee Osteoarthritis

Abstract

Objectives

Design

Setting

Participants

Interventions

Main Outcome Measure

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Acknowledgments

J Orthop Res

Osteoarth Cart

J Biomech

Clin Biomech (Bristol, Avon)

J Biomech

Osteoarth Cart

J Biomech

Osteoarth Cart

Gait Posture

Arch Phys Med Rehabil

Clin Biomech (Bristol, Avon)

J Biomech

Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital

Ann Rheum Dis

Interaction between active and passive knee stabilizers during level walking

J Orthop Res

Correlation between the knee adduction torque and medial contact force for a variety of gait patterns

J Orthop Res

Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis

Arthritis Rheum

Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis

Ann Rheum Dis

Original article
Gait Differs Between Unilateral and Bilateral Knee Osteoarthritis