Biomechanical Deviations During Level Walking Associated With Knee Osteoarthritis: A Systematic Review and Meta-Analysis
Article first published online: 24 SEP 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 10, pages 1643–1665, October 2013
How to Cite
Mills, K., Hunt, M. A. and Ferber, R. (2013), Biomechanical Deviations During Level Walking Associated With Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res, 65: 1643–1665. doi: 10.1002/acr.22015
- Issue published online: 24 SEP 2013
- Article first published online: 24 SEP 2013
- Accepted manuscript online: 1 APR 2013 12:31PM EST
- Manuscript Accepted: 20 MAR 2013
- Manuscript Received: 24 OCT 2012
- Alberta Innovates Health Solutions Team in Osteoarthritis. Grant Number: Award 200700 596
To identify which gait deviations are consistently associated with knee osteoarthritis (KOA) and how these are influenced by disease severity, the involved compartment, and sex.
Five electronic databases and reference lists of publications were searched. Cross-sectional, observational studies comparing temporospatial variables, joint kinematics, and joint moments between individuals with KOA and healthy controls or between KOA subgroups were considered for review. Only publications scoring ≥50% on a modified methodology quality index were included. Because of the number of gait deviations examined, only biomechanical variables reported by ≥4 publications were further analyzed. Where possible, a meta-analysis was performed using effect sizes (ES) calculated from discrete variables.
In total, 41 publications examining 20 variables were included. The majority of consistent gait deviations associated with KOA were exhibited by those with severe disease in the temporospatial domain. Individuals with severe KOA exhibited greater stride duration than controls (ES 1.35 [95% confidence interval (95% CI) 1.03, 1.67]) and a decrease in cadence (ES −0.75 [95% CI −1.12, −0.39]) compared with controls. The evidence for kinematic and joint moment change was primarily limited or conflicting. There was a lack of evidence for alterations in the external knee adduction moment.
Individuals with KOA exhibit a range of gait deviations compared with controls. Despite its common usage in KOA gait studies, we did not find consistent evidence that knee adduction moment differs between those with and without KOA or between disease severity levels. Further research examining the reasons for a lack of difference in many gait variables in those with knee OA is needed.