Lower extremity joint kinematics during stair climbing in knee osteoarthritis.

摘要

PURPOSE: Knee osteoarthritis (OA) is one of the most prevalent chronic lower extremity diseases, causing profound limitation of movement and ability to perform activities of daily living. The purpose of this study was to compare various hip, knee, and ankle joint kinematic variables between knee OA subjects and matched healthy controls during stair ascent and descent. METHODS: Eighteen subjects with knee OA (age = 60.2 +/- 9.9 yr, mass = 90.3 +/- 16.7 kg, height = 168.4 +/- 9.9 cm) and 18 healthy matched controls (age = 60.3 +/- 10.7 yr, mass = 81.1 +/- 21.2 kg, height = 168.3 +/- 11.9 cm) participated in the study. Subjects performed five ascending and descending trials on a custom-built staircase while their motion was captured three-dimensionally using an eight-camera optical video motion capture system. RESULTS: Significant group x direction interactions were found for average hip flexion angle at foot strike (P = 0.04), for average ankle adduction angle at foot strike (P = 0.01), and for peak ankle dorsiflexion angle during support (P = 0.05) and swing (P = 0.01). Specifically, knee OA and control subjects demonstrated greater hip flexion angle at foot strike and ankle dorsiflexion angle during swing but showed smaller ankle dorsiflexion angle during support during stair ascent compared with descent. Furthermore, compared with controls, knee OA patients demonstrated greater hip abduction at foot strike (-3.1 degrees +/- 3.9 degrees ) and smaller peak knee flexion during support (60.4 degrees +/- 5.0 degrees ) and swing (86.7 degrees +/- 5.4 degrees ). Time of peak hip abduction (34.2% +/- 7.1%), hip flexion (7.0% +/- 12.3%), knee flexion (69.8% +/- 4.6%), dorsiflexion (51.4% +/- 2.9%), and ankle adduction (37.3% +/- 20.8%) during support occurred later in the gait cycle for knee OA patients. CONCLUSIONS: These data demonstrate that knee OA directly influences specific knee joint kinematics and induces kinematic alterations at the hip and ankle perhaps to compensate for the existing knee joint pathology.