The biomechanics of osteoarthritis: Implications for therapy

The pathophysiology of osteoarthritis (OA) has been extensively studied. However, the basic approach to therapy, which consists of pain relief and maintenance of function, has not changed for decades. At present, there are no nonsurgical methods that clearly interfere with the natural history of OA or provide prolonged pain palliation. Much of OA disease progression is mediated by aberrant biomechanical forces or through pathologic responses to those forces. As understanding of these mechanisms improves, novel therapeutic approaches are being studied that may provide prolonged reductions in loading of OA joints. These new therapies may ultimately be shown to retard disease progression and palliate pain. This article reviews some of these strategies.

[1]  E. Vignon,et al.  Which is the best radiographic protocol for a clinical trial of a structure modifying drug in patients with knee osteoarthritis? , 2002, The Journal of rheumatology.

[2]  M. Andrews,et al.  Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: A critical analysis of the reliability of gait analysis data , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[3]  R. Greenwald,et al.  A biomechanical analysis of a medial unloading brace for osteoarthritis in the knee. , 2000, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[4]  J. Block,et al.  Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis. , 2007, Arthritis and rheumatism.

[5]  I. Harrington,et al.  Static and dynamic loading patterns in knee joints with deformities. , 1983, The Journal of bone and joint surgery. American volume.

[6]  Rana S. Hinman,et al.  Reducing joint loading in medial knee osteoarthritis: shoes and canes. , 2008, Arthritis and rheumatism.

[7]  K. Brandt Is a Strong Quadriceps Muscle Bad for a Patient with Knee Osteoarthritis? , 2003, Annals of Internal Medicine.

[8]  Y. Toda,et al.  A six-month followup of a randomized trial comparing the efficacy of a lateral-wedge insole with subtalar strapping and an in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee. , 2004, Arthritis and rheumatism.

[9]  T. Andriacchi,et al.  Increased knee joint loads during walking are present in subjects with knee osteoarthritis. , 2002, Osteoarthritis and cartilage.

[10]  A Guermazi,et al.  Change in joint space width: hyaline articular cartilage loss or alteration in meniscus? , 2006, Arthritis and rheumatism.

[11]  T. Andriacchi,et al.  Interaction between active and passive knee stabilizers during level walking , 1991, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[12]  M. Doherty,et al.  Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review , 2005, Annals of the rheumatic diseases.

[13]  F. Cicuttini,et al.  Longitudinal study of the relationship between knee angle and tibiofemoral cartilage volume in subjects with knee osteoarthritis. , 2004, Rheumatology.

[14]  T. Andriacchi,et al.  Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. , 1998, Arthritis and rheumatism.

[15]  T. Miyazaki,et al.  Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis , 2002, Annals of the rheumatic diseases.

[16]  D. Kerrigan,et al.  Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis. , 2002, Archives of physical medicine and rehabilitation.

[17]  A. Bakheit,et al.  A study of the gait characteristics of patients with chronic osteoarthritis of the knee , 2002, Disability and rehabilitation.

[18]  S. Gabriel,et al.  Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. , 2008, Arthritis and rheumatism.

[19]  A. Mündermann,et al.  Implications of increased medio-lateral trunk sway for ambulatory mechanics. , 2008, Journal of biomechanics.

[20]  M Stokes,et al.  The contribution of reflex inhibition to arthrogenous muscle weakness. , 1984, Clinical science.

[21]  D. Krebs,et al.  Compensatory gait mechanics in patients with unilateral knee arthritis. , 2002, The Journal of rheumatology.

[22]  P. Dieppe,et al.  Pathogenesis and management of pain in osteoarthritis , 2005, The Lancet.

[23]  T. Andriacchi,et al.  Knee pain and joint loading in subjects with osteoarthritis of the knee , 2000, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[24]  N. Fukui,et al.  Change of bone mineral density with valgus knee bracing , 1999, International Orthopaedics.

[25]  D. Hurwitz,et al.  The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis , 2007, Annals of the rheumatic diseases.

[26]  Y. Toda,et al.  The effects of different elevations of laterally wedged insoles with subtalar strapping on medial compartment osteoarthritis of the knee. , 2004, Archives of physical medicine and rehabilitation.

[27]  T. Andriacchi,et al.  A relationship between gait and clinical changes following high tibial osteotomy. , 1985, The Journal of bone and joint surgery. American volume.

[28]  A. M. Doughan,et al.  Quantification of progressive joint space narrowing in osteoarthritis of the hip: longitudinal analysis of the contralateral hip after total hip arthroplasty. , 2000, Arthritis and rheumatism.

[29]  Najia Shakoor,et al.  Nonrandom evolution of end-stage osteoarthritis of the lower limbs. , 2002, Arthritis and rheumatism.

[30]  A. Amendola,et al.  The effect of bracing on varus gonarthrosis. , 1999, The Journal of bone and joint surgery. American volume.

[31]  Thomas R Jenkyn,et al.  Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: a tri-planar kinetic mechanism. , 2008, Journal of biomechanics.

[32]  T P Andriacchi,et al.  Joint Loading With Valgus Bracing in Patients With Varus Gonarthrosis , 1997, Clinical orthopaedics and related research.

[33]  Karen Hayes,et al.  Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression. , 2005, Arthritis and rheumatism.

[34]  F. Awiszus,et al.  Funktionelle Veränderungen des Quadriceps Femoris Muskels bei Patienten mit Varusgonarthrose , 2000, Zeitschrift für Rheumatologie.

[35]  K. Yasuda,et al.  The mechanics of treatment of the osteoarthritic knee with a wedged insole. , 1987, Clinical orthopaedics and related research.

[36]  D. Hurwitz,et al.  Asymmetric knee loading in advanced unilateral hip osteoarthritis. , 2003, Arthritis and rheumatism.

[37]  K. Ogata,et al.  The effect of wedged insoles on the thrust of osteoarthritic knees , 1997, International Orthopaedics.

[38]  M. Dougados,et al.  Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study. , 2001, Osteoarthritis and cartilage.

[39]  M. Dougados,et al.  Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis11This work was supported in part by the ‘Programme Hospitalier de Recherche Clinique’ (AOM 97 184) of the French Health Ministry , 2004 .

[40]  L. Sharma,et al.  Erratum: The role of knee alignment in disease progression and functional decline in knee osteoarthritis (Journal of the American Medical Association (July 11, 2001) 284 (188-195)) , 2001 .

[41]  Radiographic joint space width (JSW): A marker of disease progression in OA of the hip , 2002 .

[42]  Naoki Suzuki,et al.  Change in the locus of dynamic loading axis on the knee joint after high tibial osteotomy. , 2005, Gait & Posture.

[43]  J. Block,et al.  Improved Precision in Quantifying Knee Alignment Angle , 2007, Clinical orthopaedics and related research.

[44]  F Dujardin,et al.  Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis. , 2001, Archives of physical medicine and rehabilitation.

[45]  T. Andriacchi,et al.  Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. , 2004, Arthritis and rheumatism.

[46]  L. Sharma,et al.  The role of knee alignment in disease progression and functional decline in knee osteoarthritis. , 2001, JAMA.

[47]  J. Block,et al.  Bone mineral density in the proximal tibia varies as a function of static alignment and knee adduction angular momentum in individuals with medial knee osteoarthritis. , 2006, Bone.

[48]  Thomas J. Schnitzer,et al.  Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update , 2000 .

[49]  S. Bierma-Zeinstra,et al.  Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. , 2006, Osteoarthritis and cartilage.

[50]  R. Hinman,et al.  Exercise as a treatment for osteoarthritis , 2005, Current opinion in rheumatology.

[51]  F. Pollo,et al.  Knee bracing for unicompartmental osteoarthritis. , 2006, The Journal of the American Academy of Orthopaedic Surgeons.

[52]  D. Felson,et al.  A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. , 2007, Arthritis and rheumatism.

[53]  T. Andriacchi,et al.  Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. , 2005, Arthritis and rheumatism.

[54]  Najia Shakoor,et al.  Effects of specialized footwear on joint loads in osteoarthritis of the knee. , 2008, Arthritis and rheumatism.

[55]  J. Block,et al.  Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis. , 2006, Arthritis and rheumatism.

[56]  T. Andriacchi,et al.  The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[57]  T Koshino,et al.  Hip Adductor Muscle Strength in Patients With Varus Deformed Knee , 2001, Clinical orthopaedics and related research.

[58]  S. Mcconnell,et al.  Exercise for osteoarthritis of the hip or knee (Protocol) , 2000 .

[59]  V. Hascall,et al.  The Many Faces of Osteoarthritis , 2002, Birkhäuser Basel.

[60]  T. Andriacchi,et al.  A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis. , 2008, Journal of biomechanics.

[61]  R. Duranti,et al.  Pain thresholds and electromyographic features of periarticular muscles in patients with osteoarthritis of the knee , 1981, PAIN.

[62]  T. Andriacchi,et al.  The influence of walking mechanics and time on the results of proximal tibial osteotomy. , 1990, The Journal of bone and joint surgery. American volume.

[63]  Laura E Thorp,et al.  Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. , 2006, Arthritis and rheumatism.

[64]  D. Kerrigan,et al.  Knee osteoarthritis and high-heeled shoes , 1998, The Lancet.

[65]  Examination of exercise effects on knee osteoarthritis outcomes: why should the local mechanical environment be considered? , 2003, Arthritis and rheumatism.

[66]  S. Mazzuca,et al.  Quadriceps Weakness and Osteoarthritis of the Knee , 1997, Annals of Internal Medicine.