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

  • Rebecca Avrin Zifchock
  • Yatin Kirane
  • Howard Hillstrom
  • The Hospital for Special Surgery Lower Extremity Realignment Research Group
Basic Research

Abstract

Background

Although the severity of knee osteoarthritis (OA) usually is assessed using different measures of joint structure, function, and pain, the relationships between these measures are unclear.

Purpose

Therefore, we: (1) examined the relationships between the measures of knee structure (flexion-extension range of motion, radiographic tibiofemoral angle, and medial joint space), function (Knee Osteoarthritis Outcome Scores [KOOS], peak adduction angle, and moment), and pain (visual analog scale [VAS]); and (2) identified variables that best predicted knee pain.

Methods

We assessed 15 patients with medial knee OA using VAS pain, KOOS questionnaire, 3-D gait analysis, and radiographic examination. Parameter relationships were assessed using Pearson correlation, and variables most predictive of knee pain were determined using a stepwise multiple regression.

Results

Subjective measurements correlated (|r| ≥ 0.54) with one another, as did most of the objective measurements (|r| ≥ 0.56) except for adduction moment which did not correlate with any variable. All variables correlated (|r| > 0.54) with VAS knee pain except peak adduction moment. Medial joint space and peak adduction angle best predicted knee pain, accounting for approximately three-quarters of the model variance (r2 = 0.73).

Conclusions

Medial joint space and peak adduction angle may be useful for predicting knee pain in patients with medial knee OA. Therapies that target these structural and functional variables may reduce knee pain in this population.

Clinical Relevance

Increasing the medial joint space and limiting the peak knee adduction angle may be critical in achieving effective pain relief in patients with varus knee OA.

Notes

Acknowledgments

We thank New Balance for providing footwear, and Össur Americas for providing knee braces for all study participants.

References

  1. 1.
    Andriacchi TP. Dynamics of knee malalignment. Orthop Clin North Am. 1994;25:395–403.PubMedGoogle Scholar
  2. 2.
    Andriacchi TP, Lang PL, Alexander EJ, Hurwitz DE. Methods for evaluating the progression of osteoarthritis. J Rehabil Res Dev. 2000;37:163–170.PubMedGoogle Scholar
  3. 3.
    Andriacchi TP, Mundermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rheumatol. 2006;18:514–518.PubMedCrossRefGoogle Scholar
  4. 4.
    Astephen Wilson JL, Deluzio KJ, Dunbar MJ, Caldwell GE, Hubley-Kozey CL. The association between knee joint biomechanics and neuromuscular control and moderate knee osteoarthritis radiographic and pain severity. Osteoarthritis Cartilage. 2011;19:186–193.PubMedCrossRefGoogle Scholar
  5. 5.
    Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, Andriacchi TP. Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis Cartilage. 2002;10:573–579.PubMedCrossRefGoogle Scholar
  6. 6.
    Barrios JA, Higginson JS, Royer TD, Davis IS. Static and dynamic correlates of the knee adduction moment in healthy knees ranging from normal to varus-aligned. Clin Biomech (Bristol, Avon). 2009;24:850–854.Google Scholar
  7. 7.
    Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskelet Disord. 2008;9:116.PubMedCrossRefGoogle Scholar
  8. 8.
    Benichou OD, Hunter DJ, Nelson DR, Guermazi A, Eckstein F, Kwoh K, Myers SL, Wirth W, Duryea J; Osteoarthritis Initiative Investigators. One-year change in radiographic joint space width in patients with unilateral joint space narrowing: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2010;62:924–931.CrossRefGoogle Scholar
  9. 9.
    Bruyere O, Genant H, Kothari M, Zaim S, White D, Peterfy C, Burlet N, Richy F, Ethgen D, Montague T, Dabrowski C, Reginster JY. Longitudinal study of magnetic resonance imaging and standard X-rays to assess disease progression in osteoarthritis. Osteoarthritis Cartilage. 2007;15:98–103.PubMedCrossRefGoogle Scholar
  10. 10.
    Butler RJ, Barrios JA, Royer T, Davis IS. Effect of laterally wedged foot orthoses on rearfoot and hip mechanics in patients with medial knee osteoarthritis. Prosthet Orthot Int. 2009;33:107–116.PubMedCrossRefGoogle Scholar
  11. 11.
    Butler RJ, Marchesi S, Royer T, Davis IS. The effect of a subject-specific amount of lateral wedge on knee mechanics in patients with medial knee osteoarthritis. J Orthop Res. 2007;25:1121–1127.PubMedCrossRefGoogle Scholar
  12. 12.
    Chang A, Hayes K, Dunlop DD, Hurwitz DE, Song J, Cahue S, Genge R, Sharma L. Thrust during ambulation and the progression of knee osteoarthritis. Arthritis Rheum. 2004;50:3897–3903.PubMedCrossRefGoogle Scholar
  13. 13.
    Chang A, Hochberg M, Song J, Dunlop D, Chmiel JS, Nevitt M, Hayes K, Eaton C, Bathon JM, Jackson R, Kwoh CK, Sharma L. Frequency of varus and valgus thrust and factors associated with thrust presence in persons with or at higher risk of developing knee osteoarthritis. Arthritis Rheum. 2010;62:1403–1411.PubMedGoogle Scholar
  14. 14.
    Charles HC, Kraus VB, Ainslie M, Hellio Le Graverand-Gastineau MP. Optimization of the fixed-flexion knee radiograph. Osteoarthritis Cartilage. 2007;15:1221–1224.PubMedCrossRefGoogle Scholar
  15. 15.
    Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D, Dieppe PA. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000;43:995–1000.PubMedCrossRefGoogle Scholar
  16. 16.
    Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. 1965. Clin Orthop Relat Res. 1989;248:4–8.PubMedGoogle Scholar
  17. 17.
    DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC. Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med. 2010;38:2077–2084.PubMedCrossRefGoogle Scholar
  18. 18.
    Dieppe PA, Cushnaghan J, Shepstone L. The Bristol ‘OA500’ study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint. Osteoarthritis Cartilage. 1997;5:87–97.PubMedCrossRefGoogle Scholar
  19. 19.
    Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005;365:965–973.PubMedCrossRefGoogle Scholar
  20. 20.
    Dougados M. Monitoring osteoarthritis progression and therapy. Osteoarthritis Cartilage. 2004;12(Suppl A):S55–60.Google Scholar
  21. 21.
    Fantini Pagani CH, Potthast W, Bruggemann GP. The effect of valgus bracing on the knee adduction moment during gait and running in male subjects with varus alignment. Clin Biomech (Bristol, Avon). 2010;25:70–76.Google Scholar
  22. 22.
    Fragomen AT, Ilizarov S, Blyakher A, Rozbruch SR. Proximal tibial osteotomy for medial compartment osteoarthritis of the knee using the Ilizarov-Taylor spatial frame. Tech Knee Surg. 2005;4:173–185.CrossRefGoogle Scholar
  23. 23.
    Fukui N, Yamane S, Ishida S, Tanaka K, Masuda R, Tanaka N, Katsuragawa Y, Fukui S. Relationship between radiographic changes and symptoms or physical examination findings in subjects with symptomatic medial knee osteoarthritis: a three-year prospective study. BMC Musculoskelet Disord. 2010;11:269.PubMedCrossRefGoogle Scholar
  24. 24.
    Gogia P, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements of the knee. Phys Ther. 1987;67:192–195.PubMedGoogle Scholar
  25. 25.
    Gossec L, Paternotte S, Maillefert JF, Combescure C, Conaghan PG, Davis AM, Gunther KP, Hawker G, Hochberg M, Katz JN, Kloppenburg M, Lim K, Lohmander LS, Mahomed NN, March L, Pavelka K, Punzi L, Roos EM, Sanchez-Riera L, Singh JA, Suarez-Almazor ME, Dougados M, OARSI-OMERACT Task Force “total articular replacement as outcome measure in OA”. The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1909 patients. report of the OARSI-OMERACT task force on total joint replacement. Osteoarthritis Cartilage. 2011;19:147–154.PubMedCrossRefGoogle Scholar
  26. 26.
    Gyory AN, Chao EY, Stauffer RN. Functional evaluation of normal and pathologic knees during gait. Arch Phys Med Rehabil. 1976;57:571–577.PubMedGoogle Scholar
  27. 27.
    Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27:1513–1517.PubMedGoogle Scholar
  28. 28.
    Harrington IJ. Static and dynamic loading patterns in knee joints with deformities. J Bone Joint Surg Am. 1983;65:247–259.PubMedGoogle Scholar
  29. 29.
    Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clin Biomech (Bristol, Avon). 2009;24:833–841.Google Scholar
  30. 30.
    Henriksen M, Graven-Nielsen T, Aaboe J, Andriacchi TP, Bliddal H. Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain. Arthritis Care Res (Hoboken). 2010;62:501–509.CrossRefGoogle Scholar
  31. 31.
    Hoher J, Munster A, Klein J, Eypasch E, Tiling T. Validation and application of a subjective knee questionnaire. Knee Surg Sports Traumatol Arthrosc. 1995;3:26–33.PubMedCrossRefGoogle Scholar
  32. 32.
    Hunt MA, Fowler PJ, Birmingham TB, Jenkyn TR, Giffin JR. Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg. 2006;49:401–406.PubMedGoogle Scholar
  33. 33.
    Hunter DJ, Sharma L, Skaife T. Alignment and osteoarthritis of the knee. J Bone Joint Surg Am. 2009;91(suppl 1):85–89.PubMedCrossRefGoogle Scholar
  34. 34.
    Hunter DJ, Zhang W, Conaghan PG, Hirko K, Menashe L, Li L, Reichmann WM, Losina E. Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthritis Cartilage. 2011;19:557–588.PubMedCrossRefGoogle Scholar
  35. 35.
    Hurwitz DE, Ryals AB, Case JP, Block JA, Andriacchi TP. 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. J Orthop Res. 2002;20:101–107.PubMedCrossRefGoogle Scholar
  36. 36.
    Hurwitz DE, Ryals AR, Block JA, Sharma L, Schnitzer TJ, Andriacchi TP. Knee pain and joint loading in subjects with osteoarthritis of the knee. J Orthop Res. 2000;18:572–579.PubMedCrossRefGoogle Scholar
  37. 37.
    Hurwitz DE, Sumner DR, Andriacchi TP, Sugar DA. Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech. 1998;31:423–430.PubMedCrossRefGoogle Scholar
  38. 38.
    Issa SN, Dunlop DD, Chang A, Song J, Prasad PV, Guermazi A, Peterfy C, Cahue S, Marshall M, Kapoor D, Hayes K, Sharma L. Full-limb and knee radiography assessments of varus-valgus alignment and their relationship to osteoarthritis disease features by magnetic resonance imaging. Arthritis Rheum. 2007;57:398–406.PubMedCrossRefGoogle Scholar
  39. 39.
    Jakobsen TL, Christensen M, Christensen SS, Olsen M, Bandholm T. Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter? Physiother Res Int. 2010;15:126–134.PubMedCrossRefGoogle Scholar
  40. 40.
    Johnson F, Leitl S, Waugh W. The distribution of load across the knee: a comparison of static and dynamic measurements. J Bone Joint Surg Br. 1980;62:346–349.PubMedGoogle Scholar
  41. 41.
    Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.PubMedCrossRefGoogle Scholar
  42. 42.
    Kirkley A, Webster-Bogaert S, Litchfield R, Amendola A, MacDonald S, McCalden R, Fowler P. The effect of bracing on varus gonarthrosis. J Bone Joint Surg Am. 1999;81:539–548.PubMedGoogle Scholar
  43. 43.
    Kothari M, Guermazi A, von Ingersleben G, Miaux Y, Sieffert M, Block JE, Stevens R, Peterfy CG. Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol. 2004;14:1568–1573.PubMedCrossRefGoogle Scholar
  44. 44.
    Kraus VB, Vail TP, Worrell T, McDaniel G. A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arthritis Rheum. 2005;52:1730–1735.PubMedCrossRefGoogle Scholar
  45. 45.
    Kuroyanagi Y, Nagura T, Kiriyama Y, Matsumoto H, Otani T, Toyama Y, Suda Y. A quantitative assessment of varus thrust in patients with medial knee osteoarthritis. Knee. 2011 Feb 5. [Epub ahead of print]Google Scholar
  46. 46.
    Lo GH, Zhang Y, McLennan C, Niu J, Kiel DP, McLean RR, Aliabadi P, Felson DT, Hunter DJ. The ratio of medial to lateral tibial plateau bone mineral density and compartment-specific tibiofemoral osteoarthritis. Osteoarthritis Cartilage. 2006;14:984–990.PubMedCrossRefGoogle Scholar
  47. 47.
    Maly MR, Costigan PA, Olney SJ. Mechanical factors relate to pain in knee osteoarthritis. Clin Biomech (Bristol, Avon). 2008;23:796–805.Google Scholar
  48. 48.
    McNicholas MJ, Gibbs S, Linskell JR, Barker S, McGurty D, Rowley DI. The influence of external knee moments on the outcome of total meniscectomy: a comparison of radiological and 3-D gait analysis measurements. Gait Posture. 2000;11:233–238.PubMedCrossRefGoogle Scholar
  49. 49.
    Messier SP, Loeser RF, Hoover JL, Semble EL, Wise CM. Osteoarthritis of the knee: effects on gait, strength, and flexibility. Arch Phys Med Rehabil. 1992;73:29–36.PubMedGoogle Scholar
  50. 50.
    Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. 2002;61:617–622.PubMedCrossRefGoogle Scholar
  51. 51.
    Mmanipphyty CM, Nicholson H, Baxter GD, Abbott JH. Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies. Arthritis Care Res (Hoboken). 2011 May 10. [Epub ahead of print]Google Scholar
  52. 52.
    Moyer RF, Birmingham TB, Chesworth BM, Kean CO, Giffin JR. Alignment, body mass and their interaction on dynamic knee joint load in patients with knee osteoarthritis. Osteoarthritis Cartilage. 2010;18:888–893.PubMedCrossRefGoogle Scholar
  53. 53.
    Mundermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. Arthritis Rheum. 2005;52:2835–2844.PubMedCrossRefGoogle Scholar
  54. 54.
    Neogi T, Felson D, Niu J, Nevitt M, Lewis CE, Aliabadi P, Sack B, Torner J, Bradley L, Zhang Y. Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ. 2009;339:b2844.PubMedCrossRefGoogle Scholar
  55. 55.
    Ozdemir F, Tukenmez O, Kokino S, Turan FN. How do marginal osteophytes, joint space narrowing and range of motion affect each other in patients with knee osteoarthritis. Rheumatol Int. 2006;26:516–522.PubMedCrossRefGoogle Scholar
  56. 56.
    Perry J. Gait Analysis: Normal and Pathological Function, 1st edn. Thorofare, NJ: Slack Incorporated; 1992.Google Scholar
  57. 57.
    Prodromos CC, Andriacchi TP, Galante JO. A relationship between gait and clinical changes following high tibial osteotomy. J Bone Joint Surg Am. 1985;67:1188–1194.PubMedGoogle Scholar
  58. 58.
    Ramsey DK, Briem K, Axe MJ, Snyder-Mackler L. A mechanical theory for the effectiveness of bracing for medial compartment osteoarthritis of the knee. J Bone Joint Surg Am. 2007;89:2398–2407.PubMedCrossRefGoogle Scholar
  59. 59.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88–96.PubMedGoogle Scholar
  60. 60.
    Roos EM, Toksvig-Larsen S. Knee injury and Osteoarthritis Outcome Score (KOOS): validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes. 2003;1:17.PubMedCrossRefGoogle Scholar
  61. 61.
    Rozbruch SR, Fragomen AT, Ilizarov S. Correction of tibial deformity with use of the Ilizarov-Taylor spatial frame. J Bone Joint Surg Am. 2006;88(suppl 4):156–174.PubMedCrossRefGoogle Scholar
  62. 62.
    Sahlstrom A, Johnell O, Redlund-Johnell I. The natural course of arthrosis of the knee. Clin Orthop Relat Res. 1997;340:152–157.PubMedCrossRefGoogle Scholar
  63. 63.
    Schnitzer TJ, Popovich JM, Andersson GB, Andriacchi TP. Effect of piroxicam on gait in patients with osteoarthritis of the knee. Arthritis Rheum. 1993;36:1207–1213.PubMedCrossRefGoogle Scholar
  64. 64.
    Schwartz MH, Rozumalski A. A new method for estimating joint parameters from motion data. J Biomech. 2005;38:107–116.PubMedCrossRefGoogle Scholar
  65. 65.
    Sharma L. Local factors in osteoarthritis. Curr Opin Rheumatol. 2001;13:441–446.PubMedCrossRefGoogle Scholar
  66. 66.
    Sharma L, Hurwitz DE, Thonar EJ, Sum JA, Lenz ME, Dunlop DD, Schnitzer TJ, Kirwan-Mellis G, Andriacchi TP. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis Rheum. 1998;41:1233–1240.PubMedCrossRefGoogle Scholar
  67. 67.
    Sharma L, Song J, Dunlop D, Felson D, Lewis CE, Segal N, Torner J, Cooke TD, Hietpas J, Lynch J, Nevitt M. Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis. 2010;69:1940–1945.PubMedCrossRefGoogle Scholar
  68. 68.
    Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001;286:188–195.PubMedCrossRefGoogle Scholar
  69. 69.
    Spahn G, Kirschbaum S, Kahl E. Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthritis Cartilage. 2006;14:190–195.PubMedCrossRefGoogle Scholar
  70. 70.
    Specogna AV, Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR. Radiographic measures of knee alignment in patients with varus gonarthrosis: Effect of weightbearing status and associations with dynamic joint load. Am J Sports Med. 2007;35:65–70.PubMedCrossRefGoogle Scholar
  71. 71.
    Thorp LE, Sumner DR, Wimmer MA, Block JA. Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis. Arthritis Rheum. 2007;57:1254–1260.PubMedCrossRefGoogle Scholar
  72. 72.
    Wang D, Jones MH, Khair MM, Miniaci A. Patient-reported outcome measures for the knee. J Knee Surg. 2010;23:137–151.PubMedCrossRefGoogle Scholar
  73. 73.
    Wang JW, Kuo KN, Andriacchi TP, Galante JO. The influence of walking mechanics and time on the results of proximal tibial osteotomy. J Bone Joint Surg Am. 1990;72:905–909.PubMedGoogle Scholar
  74. 74.
    Watkins MA, Riddle DL, Lamb RL, Personius WJ. Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. Phys Ther. 1991;71:90–96; discussion 96–97.Google Scholar
  75. 75.
    Weidenhielm L, Olsson E, Brostrom LA, Borjesson-Hederstrom M, Mattsson E. Improvement in gait one year after surgery for knee osteoarthrosis: a comparison between high tibial osteotomy and prosthetic replacement in a prospective randomized study. Scand J Rehabil Med. 1993;25:25–31.PubMedGoogle Scholar
  76. 76.
    Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg MC, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: Changes in evidence following systematic cumulative update of research published through january 2009. Osteoarthritis Cartilage. 2010;18:476–499.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Rebecca Avrin Zifchock
    • 1
  • Yatin Kirane
    • 1
  • Howard Hillstrom
    • 1
  • The Hospital for Special Surgery Lower Extremity Realignment Research Group
    • 1
  1. 1.Leon Root, MD Motion Analysis LaboratoryDepartment of Rehabilitation, Hospital for Special SurgeryNew YorkUSA

Personalised recommendations