Strong independent associations between gait biomechanics and pain in patients with knee osteoarthritis

Kendal A Marriott; Trevor B Birmingham; Kristyn M Leitch; Ryan Pinto; J Robert Giffin

doi:10.1016/j.jbiomech.2019.07.015

Strong independent associations between gait biomechanics and pain in patients with knee osteoarthritis

J Biomech. 2019 Sep 20:94:123-129. doi: 10.1016/j.jbiomech.2019.07.015. Epub 2019 Jul 25.

Authors

Kendal A Marriott¹, Trevor B Birmingham², Kristyn M Leitch³, Ryan Pinto⁴, J Robert Giffin⁵

Affiliations

¹ Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada.
² Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre - University Hospital, London, ON N6A 5B5, Canada. Electronic address: tbirming@uwo.ca.
³ Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre - University Hospital, London, ON N6A 5B5, Canada.
⁴ Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre - University Hospital, London, ON N6A 5B5, Canada.
⁵ Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre - University Hospital, London, ON N6A 5B5, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, St. Joseph's Health Care London, London, ON N6A 4V2, Canada.

PMID: 31421807
DOI: 10.1016/j.jbiomech.2019.07.015

Abstract

We investigated the simple and multivariate associations between knee pain and gait biomechanics. 279 patients with medial knee osteoarthritis (OA) and discordant changes in pain between limbs after walking completed bilateral three-dimensional gait analysis. For each limb, patients rated their pain before and after a 6-min walk and the change in pain was recorded as an increase (≥1 points) or not (≤0 points). Among paired limbs, the simple and multivariate associations between an increase in pain and the external moments in each orthogonal plane were evaluated using conditional logistic regression. The analyses were then repeated for knee angles. Univariate analyses demonstrated associations in each plane that varied in both magnitude and direction, with larger associations for the knee moments [Odds Ratio (95% confidence interval) = first peak adduction moment: 2.80 (2.02, 3.88), second peak adduction moment: 2.36 (1.73, 3.24), adduction impulse: 6.65 (3.50, 12.62), flexion moment: 0.46 (0.36, 0.60), extension moment: 0.56 (0.44, 0.71), internal rotation moment: 7.54 (3.32, 17.13), external rotation moment: 0.001 (0.00, 0.04)]. Multivariate analyses with backward elimination resulted in a model including only the adduction impulse [5.35 (2.51, 11.42)], flexion moment [0.32 (0.22, 0.46)] and extension moment [0.28 (0.19, 0.42)]. The varus, flexion and extension angles were included in the final multivariate model for the knee angles. When between-person confounding is lessened by comparing limbs within patients, there are strong independent associations between knee pain and multiple external knee moments that vary in magnitude and direction. While controlling for other knee moments, a greater adduction impulse and lower flexion and extension moments were independently associated with greater odds of an increase in pain.

Keywords: Biomechanics; Osteoarthritis; Pain.

MeSH terms

Adult
Biomechanical Phenomena
Female
Gait / physiology*
Humans
Knee Joint / physiopathology
Male
Middle Aged
Osteoarthritis, Knee / physiopathology*
Pain / physiopathology*
Range of Motion, Articular
Rotation