Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

C M Dzialo,M Mannisi,K S Halonen,M De Zee,J Woodburn,M S Andersen

doi:10.1080/23335432.2019.1629839

C M Dzialo, M Mannisi + Show 4 more

Open Access

https://doi.org/10.1080/23335432.2019.1629839

Copy DOI

Abstract

ABSTRACT Gait modifications and laterally wedged insoles are non-invasive approaches used to treat medial compartment knee osteoarthritis. However, the outcome of these alterations is still a controversial topic. This study investigates how gait alteration techniques may have a unique effect on individual patients; and furthermore, the way we scale our musculoskeletal models to estimate the medial joint contact force may influence knee loading conditions. Five patients with clinical evidence of medial knee osteoarthritis were asked to walk at a normal walking speed over force plates and simultaneously 3D motion was captured during seven conditions (0°-, 5°-, 10°-insoles, shod, toe-in, toe-out, and wide stance). We developed patient-specific musculoskeletal models, using segmentations from magnetic resonance imaging to morph a generic model to patient-specific bone geometries and applied this morphing to estimate muscle insertion sites. Additionally, models were created of these patients using a simple linear scaling method. When examining the patients’ medial compartment contact force (peak and impulse) during stance phase, a ‘one-size-fits-all’ gait alteration aimed to reduce medial knee loading did not exist. Moreover, the different scaling methods lead to differences in medial contact forces; highlighting the importance of further investigation of musculoskeletal modeling methods prior to use in the clinical setting.

Highlights

Knee osteoarthritis (KOA) is a leading cause of global disability due to the irreversible deterioration of knee joint cartilage (Cross et al 2014)
The objectives of this study were (1) to determine how gait alterations (LWI or gait modifications) influence knee loading through use of patient-specific musculoskeletal modeling, (2) identify which alteration minimizes medial contact force (MCF) at the individual and patient-group level, and (3) investigate if we reach the same conclusions using a simple linearly scaled (LS) model when compared to a non-linear magnetic resonance imaging (MRI)-based model
Average differences, calculated between LS-based and MRI-based models, for knee flexion angle (KFA) ROM (8.75 ± 2.57°), peak knee flexion moment (KFM) (0.81 ± 0.47 %BW*BH), and KFM impulse (0.044 ± 0.084 %BW*BH*s) were extracted (Supplementary Table 2). Both on a group and individual patient level, for both modeling techniques, the gait alteration that achieved the greatest reduction in KFM measures was comparable to our knee adduction moment (KAM) findings (Supplementary Tables 2 and 4)

Summary

Introduction

Knee osteoarthritis (KOA) is a leading cause of global disability due to the irreversible deterioration of knee joint cartilage (Cross et al 2014). As the age at which patients receive the replacement is decreasing (Losina et al 2012; Goudie et al 2017) and human life expectancy increasing, it is only natural that the rate of revision surgeries is increasing (Pabinger et al 2013; Chawla et al 2017). It has been shown that patients undergoing TKR at an early age will have more wear of the implant than those of older patients (Fernandez-Fernandez and Rodriguez-Merchan 2015). The need for nonsurgical interventions to treat early-stage KOA is great; to delay the onset of late-stage KOA and the age at which joint replacement surgery may become a viable option

Objectives

Methods

Results

Conclusion