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Asymmetry of the knee extension deficit in standing affects weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis

Knee Surgery, Sports Traumatology, Arthroscopy volume 22, pages 2608–2613 (2014)Cite this article

Abstract

Purpose

The aim of this study was to evaluate weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis (OA) and to clarify the gait parameters affecting the weight-bearing distribution during both standing and walking using gait analysis.

Methods

Twenty-five patients (averaged 71 years) with symptomatic bilateral end-stage medial knee OA participated in this study. They performed relaxed standing, placing one foot on a force plate and thereafter, level walking. First, knee resultant force was calculated on bilateral knees during standing. The knees in each patient were divided into Higher and Lower force side for the definition of dominant side limb. Second, gait parameters in each subject were compared between both sides.

Results

Each patient had large weight-bearing asymmetry, though passive range of motion, subjective pain level, femorotibial angle and radiographic disease severities were not significantly different between both sides. In standing, knees on Higher force side were significantly extended (11.2 ± 6.5°) than on Lower force side (14.4 ± 7.3°, P = 0.0086). Similarly, knees on Higher force side were also significantly extended at heel strike during gait. Besides, peak values of extension moment, knee adduction moment, knee adduction moment impulse and vertical force during gait were significantly greater on Higher force side.

Conclusions

Ability to extend the knee in standing was considered to be an essential factor to decide loading condition. It is clinically important to examine the ability to extend the knee in standing when considering loading asymmetry during gait in patients with bilateral knee OA.

Level of evidence

III.

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Acknowledgments

The authors gratefully acknowledge the valuable contribution of Yuji Kuroyanagi, M.D., PhD, Sumi Yamashita and Yoshimori Kiriyama, PhD. No benefits or funds were received in this article.

Conflict of interest

The authors declare no conflict of interest.

Author information

Affiliations

  1. Department of Orthopedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Kengo Harato, Takeo Nagura, Hideo Matsumoto, Toshiro Otani, Yoshiaki Toyama & Yasunori Suda

  2. Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, 12-1, Shinkawadouri, Kawasakiku, Kawasaki, Kanagawa Prefecture, 210-0013, Japan

    Kengo Harato

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  1. Kengo Harato
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  2. Takeo Nagura
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  3. Hideo Matsumoto
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  4. Toshiro Otani
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  5. Yoshiaki Toyama
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  6. Yasunori Suda
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Correspondence to Kengo Harato.

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Harato, K., Nagura, T., Matsumoto, H. et al. Asymmetry of the knee extension deficit in standing affects weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 22, 2608–2613 (2014). https://doi.org/10.1007/s00167-013-2442-y

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  • DOI: https://doi.org/10.1007/s00167-013-2442-y

Keywords

  • End-stage knee osteoarthritis
  • Weight-bearing distribution
  • Gait analysis
  • Standing
  • Extension deficit