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

Abstract

Objective: To test the hypothesis that dynamic load at baseline can predict radiographic disease progression in patients with medial compartment knee osteoarthritis (OA). Methods: During 1991-93 baseline data were collected by assessment of pain, radiography, and gait analysis in 106 patients referred to hospital with medial compartment knee OA. At the six year follow up, 74 patients were again examined to assess radiographic changes. Radiographic disease progression was defined as more than one grade narrowing of minimum joint space of the medial compartment. Results: In the 32 patients showing disease progression, pain was more severe and adduction moment was higher at baseline than in those without disease progression (n=42). Joint space narrowing of the medial compartment during the six year period correlated significantly with the adduction moment at entry. Adduction moment correlated significantly with mechanical axis (varus alignment) and negatively with joint space width and pain score. Logistic regression analysis showed that the risk of progression of knee OA increased 6.46 times with a 1% increase in adduction moment. Conclusions:The results suggest that the baseline adduction moment of the knee, which reflects the dynamic load on the medial compartment, can predict radiographic OA progression at the six year follow up in patients with medial compartment knee OA.

Prognostic factors of progression of osteoarthritis of the knee: A systematic review of observational studies

“…A nonsignificant relationship between the varus alignment and progression of OA was only found in the analysis of the K/L grade 0 -1 group in the study by Cerejo et al (10). In the study by Miyazaki et al (22), a statistically significant OR was found for the univariate analysis of varus alignment and progression of knee OA (OR 3.10, 95% CI 1.07-9.12), but not in the multivariate analysis. Cerejo et al (10) and Sharma et al (14) also investigated the relationship between valgus alignment and progression of Bruyere (42) Yes vs no (22) also investigated the association between the adduction moment and progression of OA.…”

“…No statistically significant relationship was found in the comparison of the middle tertile versus the lowest tertile in the group with baseline K/L grade 1 or higher or grade 2 or higher (OR 2.3, 95% CI 0.8 -6.4 and OR 1.8, 95% CI 0.4 -8.2, respectively) and in the comparison of the highest versus the lowest tertile in the group with baseline K/L grade 1 or higher. The studies by Dieppe et al (19), Miyazaki et al (22), and Spector et al (15) found no statistically significant relationship between BMI and the progression of OA. Schouten et al (37) found a significant association in the 2 highest quartiles versus the lowest quartile.…”

“…Ledingham et al (21) reported an association between sex and the change in cyst number but not between sex and change in K/L grade or joint space narrowing (JSN). Miyazaki et al (22), Schouten et al (37), Spector et al (39), and Wolfe and Lane (45) found no significant association between sex and progression of knee OA.…”

“…Three studies (10,14,22) reported a statistically significant association between varus alignment and progression of OA measured by a decrease in JSW. A nonsignificant relationship between the varus alignment and progression of OA was only found in the analysis of the K/L grade 0 -1 group in the study by Cerejo et al (10).…”

Are Joint Structure and Function Related to Medial Knee OA Pain? A Pilot Study

“…In medial knee OA with a varus malalignment, which is the most common presentation, the knee adduction angle and (externally referenced) adduction moment during gait are considered important [6,11,21,29]. The knee adduction moment is considered a surrogate of medial compartment load [1], and has been correlated with pain in medial knee OA [71], disease severity [66], and rate of disease progression [50]. However, gait analysis is not a part of routine clinical examinations of patients with knee OA.…”