Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis.

OBJECTIVE The adduction moment at the knee during gait is the primary determinant of medial-to-lateral load distribution. If the adduction moment contributes to progression of osteoarthritis (OA), then patients with advanced medial tibiofemoral OA should have higher adduction moments. The present study was undertaken to investigate the hypothesis that the adduction moment normalized for weight and height is associated with medial tibiofemoral OA disease severity after controlling for age, sex, and pain level, and to examine the correlation of serum hyaluronan (HA) level with disease severity and with the adduction moment in a subset of patients. METHODS Fifty-four patients with medial tibiofemoral OA underwent gait analysis and radiographic evaluation. Disease severity was assessed using the Kellgren-Lawrence (K-L) grade and medial joint space width. In a subset of 23 patients with available sera, HA was quantified by sandwich enzyme-linked immunosorbent assay. Pearson correlations, a random effects model, and multivariate regression models were used. RESULTS The adduction moment correlated with the K-L grade in the left and right knees (r = 0.68 and r = 0.60, respectively), and with joint space width in the left and right knees (r = -0.45 and r = -0.47, respectively). The relationship persisted after controlling for age, sex, and severity of pain. The partial correlation between K-L grade and adduction moment was 0.71 in the left knees and 0.61 in the right knees. For every 1.0-unit increase in adduction moment, there was a 0.63-mm decrease in joint space width. In the subset of patients in whom serum HA levels were measured, HA levels correlated with medial joint space width (r = -0.55), but not with the adduction moment. CONCLUSION There is a significant relationship between the adduction moment and OA disease severity. Serum HA levels correlate with joint space width but not with the adduction moment. Longitudinal studies will be necessary to determine the contribution of the adduction moment, and its contribution in conjunction with metabolic markers, to progression of medial tibiofemoral OA.

[1]  D. Resnick,et al.  Compartmental evaluation of osteoarthritis of the knee. A comparative study of available diagnostic modalities. , 1975, Radiology.

[2]  C. Ranawat,et al.  A comparison of four models of total knee-replacement prostheses. , 1976, The Journal of bone and joint surgery. American volume.

[3]  R. N. Stauffer,et al.  Functional evaluation of normal and pathologic knees during gait. , 1976, Archives of physical medicine and rehabilitation.

[4]  R. N. Stauffer,et al.  Biomechanical gait analysis of the diseased knee joint. , 1977, Clinical orthopaedics and related research.

[5]  W Waugh,et al.  The distribution of load across the knee. A comparison of static and dynamic measurements. , 1980, The Journal of bone and joint surgery. British volume.

[6]  P. Leung,et al.  The vessels of the first metatarsal web space. An operative and radiographic study. , 1983, The Journal of bone and joint surgery. American volume.

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

[8]  T. P. Andriacchi,et al.  Gait Analysis as a Tool to Assess Joint Kinetics , 1985 .

[9]  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.

[10]  R. Moskowitz,et al.  Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. , 1986, Arthritis and rheumatism.

[11]  T D Cooke,et al.  Radiographic assessment of progression in osteoarthritis. , 1987, Arthritis and rheumatism.

[12]  J. Dingle,et al.  In vivo studies of articular tissue damage mediated by catabolin/interleukin 1. , 1987, Annals of the rheumatic diseases.

[13]  T P Andriacchi,et al.  Interaction between intrinsic knee mechanics and the knee extensor mechanism , 1987, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[14]  P. Bartold.  Interleukin-1 stimulates proteoglycan and hyaluronic acid production by human gingival fibroblasts in vitro. , 1988, Australian dental journal.

[15]  J. Hamilton,et al.  Stimulation of the hyaluronic acid levels of human synovial fibroblasts by recombinant human tumor necrosis factor α, tumor necrosis factor β (lymphotoxin), interleukin-1α, and interleukin-1β , 1988 .

[16]  J. Kelsey,et al.  Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. , 1989, The Journal of rheumatology.

[17]  L. Larsson,et al.  Gait analysis in patients with gonarthrosis treated by high tibial osteotomy. , 1989, Clinical orthopaedics and related research.

[18]  E. Thonar,et al.  Accumulation of hyaluronate in human lung carcinoma as measured by a new hyaluronate ELISA. , 1989, Connective tissue research.

[19]  S. Kleinau,et al.  Elevated levels of serum hyaluronate and correlation with disease activity in experimental models of arthritis. , 1989, Arthritis and rheumatism.

[20]  T. Andriacchi,et al.  Gait Adaptations by Patients Who Have a Deficient Anterior Cruciate Ligament , 1990 .

[21]  A. Poole,et al.  Inflammation and cartilage metabolism in rheumatoid arthritis. Studies of the blood markers hyaluronic acid, orosomucoid, and keratan sulfate. , 1990, Arthritis and rheumatism.

[22]  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.

[23]  E. Thonar,et al.  Elevated plasma levels of hyaluronate in patients with osteoarthritis and rheumatoid arthritis. , 1991, Arthritis and rheumatism.

[24]  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.

[25]  T. Andriacchi,et al.  Musculoskeletal dynamics, locomotion, and clinical applications , 1991 .

[26]  J. Dingle,et al.  The sensitivity of synthesis of human cartilage matrix to inhibition by IL‐1 suggests a mechanism for the development of osteoarthritis , 1991, Cell biochemistry and function.

[27]  M Lequesne,et al.  Longitudinal radiologic evaluation of osteoarthritis of the knee. , 1992, The Journal of rheumatology.

[28]  B. Caterson,et al.  Influence of interleukin-1 on the morphology and proteoglycan metabolism of cultured bovine articular chondrocytes. , 1992, Connective tissue research.

[29]  C M Wise,et al.  Osteoarthritis of the knee: effects on gait, strength, and flexibility. , 1992, Archives of physical medicine and rehabilitation.

[30]  D. Felson,et al.  Weight Loss Reduces the Risk for Symptomatic Knee Osteoarthritis in Women , 1992, Annals of Internal Medicine.

[31]  H. Valkenburg,et al.  A 12 year follow up study in the general population on prognostic factors of cartilage loss in osteoarthritis of the knee. , 1992, Annals of the rheumatic diseases.

[32]  T. Spector,et al.  Radiological progression of osteoarthritis: an 11 year follow up study of the knee. , 1992, Annals of the rheumatic diseases.

[33]  T P Andriacchi,et al.  The anterior cruciate ligament-deficient knee with varus alignment , 1992, The American journal of sports medicine.

[34]  T. Spector,et al.  Radiographic assessment of osteoarthritis in population studies: whither Kellgren and Lawrence? , 1993, Osteoarthritis and cartilage.

[35]  T. Andriacchi,et al.  Effect of piroxicam on gait in patients with osteoarthritis of the knee. , 1993, Arthritis and rheumatism.

[36]  H. Valkenburg,et al.  Insulin-like growth factor-1: a prognostic factor of knee osteoarthritis. , 1993, British journal of rheumatology.

[37]  S. Messier,et al.  Osteoarthritis of the knee and associated factors of age and obesity: effects on gait. , 1994, Medicine and science in sports and exercise.

[38]  T. Spector,et al.  Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. , 1994, Annals of the rheumatic diseases.

[39]  M Lequesne,et al.  Guidelines for testing slow acting drugs in osteoarthritis. , 1994, The Journal of rheumatology. Supplement.

[40]  T. Andriacchi.  Dynamics of knee malalignment. , 1994, The Orthopedic clinics of North America.

[41]  P. Wolf,et al.  The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. , 1994, American journal of public health.

[42]  K. Fukuo,et al.  Transcriptional suppression by interleukin‐1 and interferon‐γ of type II collagen gene expression in human chondrocytes , 1994 .

[43]  D. Felson,et al.  The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. , 1995, Arthritis and rheumatism.

[44]  E. Thonar,et al.  Serum hyaluronic acid level as a predictor of disease progression in osteoarthritis of the knee. , 1995, Arthritis and rheumatism.

[45]  P. Dieppe,et al.  Relationship between serum cartilage oligomeric matrix protein levels and disease progression in osteoarthritis of the knee joint. , 1995, British journal of rheumatology.

[46]  M Lequesne,et al.  Atlas of individual radiographic features in osteoarthritis. , 1995, Osteoarthritis and cartilage.

[47]  A. Jones,et al.  Factors affecting radiographic progression of knee osteoarthritis. , 1995, Annals of the rheumatic diseases.

[48]  Splinter hemorrhages following arterial puncture. , 1996, Arthritis and rheumatism.

[49]  Nicholas Bellamy,et al.  Design and conduct of clinical trials in patients with osteoarthritis : Recommendations from a task force of the Osteoarthritic Research Society , 1996 .

[50]  D. Felson,et al.  Relation of Dietary Intake and Serum Levels of Vitamin D to Progression of Osteoarthritis of the Knee among Participants in the Framingham Study , 1996, Annals of Internal Medicine.

[51]  M. Dougados,et al.  Radiographic assessment of knee osteoarthritis: reproducibility and sensitivity to change. , 1996, The Journal of rheumatology.

[52]  E. Thonar,et al.  The superficial layer of human articular cartilage is more susceptible to interleukin-1-induced damage than the deeper layers. , 1996, Arthritis and rheumatism.

[53]  A. Jones,et al.  Association between synovial fluid levels of inorganic pyrophosphate and short term radiographic outcome of knee osteoarthritis. , 1996, Annals of the rheumatic diseases.

[54]  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.

[55]  H. Yack,et al.  Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation , 1997 .

[56]  T. Spector,et al.  Low-level increases in serum C-reactive protein are present in early osteoarthritis of the knee and predict progressive disease. , 1997, Arthritis and rheumatism.