Different Prevention and Treatment Strategies for Knee Osteoarthritis (KOA) with Various Lower Limb Exoskeletons – A Comprehensive Review

Abstract

SUMMARY It was reported that about 10% of people suffer from painful knee arthritis, and a quarter of them were severely disabled. The core activities of daily living were severely limited by knee osteoarthritis (KOA). In order to reduce knee pain and prolong the life of the knee joint, there has been an increasing demand on the development of exoskeletons, for prevention and treatment. The course of KOA was closely related to the biomechanics of knee joint, and the pathogenesis was summarized based on the biomechanics of knee joint. For the prevention and clinical treatment, exoskeletons are classified into three categories: prevention, treatment, and rehabilitation after the operation. Furthermore, the design concepts, actuators, sensors, control strategies, and evaluation criteria were presented. Finally, the shortcomings and limitations were summarized. It is useful for researchers to develop suitable exoskeletons in the future.

A Review on the Rehabilitation Exoskeletons for the Lower Limbs of the Elderly and the Disabled

“…The interaction control theory has been developed for a long time, and it has been rather mature for the rehabilitation exoskeletons during one rehabilitation process. There was no need to demand the real-time performance of the control methods because the rehabilitation process was usually reduced to a slow process [9]. However, there was lacking rehabilitation strategy control which usually was made by the doctors.…”

“…The efficiency evaluation of rehabilitation exoskeletons can be divided into task-based evaluation, kinematic and kinetics evaluation, and interaction evaluation. In task-based evaluation, walking speed and walking distance are direct indicators of the training results, and the corresponding data can be obtained through the 5 min walking test (5MWT) [9], 6 min walking test (6MWT), 10 m walking test (10MWT) [74], and timed up and go (TUG). Besides, endurance [75], versatility [76], and max speed [77] were used to evaluate the performance of the rehabilitation exoskeletons under specific tasks.…”

“…The vigorous development of exoskeletal technology has brought new ideas regarding the rehabilitation and medical treatment of patients with motor dysfunction, which is expected to help such people complete their daily physiological activities or even reshape their motion function [9]. To fully understand the efforts on rehabilitation exoskeletons, this paper reviews the published works on rehabilitation exoskeletons from 2003 to 2021 in the Web of Science database [10].…”

“…The exoskeleton systems were identified as wearable man-machine devices made through anthropomorphic design, providing active assistance to the users according to their motion intention. This is one of the most promising potential technical studies to deal with the problems of disabled care and elderly assistance and rehabilitation [9]. The design of rehabilitation exoskeletons should match the ergonomic principles to guarantee that the system can correspond with the distribution of human joints.…”

Current and novel theranostic modalities for knee osteoarthritis

“…Most of the current therapeutic methods that have been used to prevent further damage, can only reduce the pain. In general, conventional treatments for KOA are classified into two major categories: surgical and non-surgical therapies [14]. Non-surgical treatments -including pharmacological and non-pharmacological approaches, have been recommended by American College of Rheumatology (ACR) as the first line treatments for KOA [15].…”