Do individuals with knee osteoarthritis walk with distinct knee biomechanics and muscle activation characteristics? An investigation of knee osteoarthritis, hip osteoarthritis, and asymptomatic groups

Background: Biomechanical markers including reductions in sagittal plane kinematics and moments, increases in knee adduction moments (KAM), and altered muscle activations have been identified as hallmark indicators of knee osteoarthritis (OA). However, it remains unknown whether these features of knee OA gait are exclusive to the diseased joint.

Research question: To determine whether specific gait outcomes previously linked to symptomatic medial compartment knee OA are unique to knee OA by concurrently investigating a group of asymptomatic individuals and those with hip OA.

Methods: 16 individuals with moderate medial compartment knee OA, 16 individuals with moderate hip OA, and 16 asymptomatic controls were recruited. Participants walked on a treadmill while segment kinematics and ground reaction forces were recorded. Sagittal plane kinematics and sagittal and frontal plane moments were calculated. Surface electromyograms were recorded from lateral and medial hamstrings and gastrocnemius and vastus lateralis and medialis. Discrete variable analysis was used to investigate knee joint mechanics and muscle activation ratios. Analysis of Variance models using Bonferroni corrections determined between group differences (α = 0.0167).

Results: Sagittal plane knee kinematics and moments were statistically similar among all groups (p > 0.0167). No differences were found for peak KAM and impulse between knee OA and asymptomatic groups (p > 0.0167) but peak KAM (p = 0.006 and impulse (p = 0.001) were greater in the knee OA group compared to hip OA. The hip OA group had a lower KAM impulse (p < 0.0167) compared to the knee OA and asymptomatic groups. A greater LH:MH activation ratio (p < 0.0167) was found in the knee OA group compared to hip OA and asymptomatic groups. No other activation ratio differences were found (p > 0.0167).

Significance: Medial and lateral hamstring muscle activation levels may provide utility as a knee OA gait biomarker compared to biomechanical outcomes, quadriceps and gastrocnemius activation, when differentiating knee OA from asymptomatic and hip OA cohorts.