Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis
Article first published online: 1 JUN 2004
Copyright © 1998 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 41, Issue 7, pages 1233–1240, July 1998
How to Cite
Sharma, L., Hurwitz, D. E., Thonar, E. J.-M. A., Sum, J. A., Lenz, M. E., Dunlop, D. D., Schnitzer, T. J., Kirwan-Mellis, G. and Andriacchi, T. P. (1998), Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis & Rheumatism, 41: 1233–1240. doi: 10.1002/1529-0131(199807)41:7<1233::AID-ART14>3.0.CO;2-L
- Issue published online: 1 JUN 2004
- Article first published online: 1 JUN 2004
- Manuscript Accepted: 30 JAN 1998
- Manuscript Received: 3 NOV 1997
- NIH. Grant Numbers: AR-30692, AR-20702-17, AR-39239-06, AG-04736, 2-P50-AR39239
The adduction moment at the knee during gait is the primary determinant of medial-tolateral 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.
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.
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.
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.