Advertisement

Relationships between performance and kinematic/kinetic variables of stair descent in patients with medial knee osteoarthritis: An evaluation of dynamic stability using an extrapolated center of mass

      Highlights

      • We evaluated dynamic stability control during stepping down in patients with knee osteoarthritis.
      • The degree of dynamic stability control was quantified by calculating the extrapolated center of mass.
      • Patients with high dynamic stability control were able to move their extrapolated center of mass more anteriorly at the initiation of step down.
      • Adequate ankle joint dorsiflexion and plantar flexor torque generation would improve the performance during stair descent.

      Abstract

      Background

      The ability to descend stairs independently is impaired from a relatively early stage in patients with knee osteoarthritis. The purpose of this study was to evaluate the performance in patients with knee osteoarthritis when stepping down a step by evaluating the dynamic stability using the extrapolated center of mass.

      Methods

      Twenty-three individuals with medial knee osteoarthritis were evaluated during step descent without any assistance. Kinematic/kinetic data were collected using a three-dimensional motion analysis system and force platforms. The extrapolated center of mass and its deviation from the anterior boundary on the base of support (margin of stability) were calculated at the initiation of descent. Joint angles and internal joint moments were collected at the stance limb. The relationship between patients' dynamic stability control, which was measured by the timed up and go test, and the length of margin of stability was analyzed. Relationships between the length of the margin of stability and each kinematic/kinetic variable were also evaluated.

      Findings

      The margin of stability positively correlated with the time taken for a timed up and go test. A positive correlation was additionally observed between the ankle dorsiflexion angle and the margin of stability. It was also found that a higher ratio of ankle plantar flexion moment by support moment was associated with a larger margin of stability.

      Interpretation

      Patients with knee osteoarthritis who had high ability in dynamic stability control were observed to move their center of mass anteriorly at the initiation of stepping down. It was also suggested that these patients could dorsiflex their ankle joint and generate sufficient ankle plantar flexor torque.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Arampatzis A.
        • Karamanidis K.
        • Mademli L.
        Deficits in the way to achieve balance related to mechanisms of dynamic stability control in the elderly.
        J. Biomech. 2008; 41: 1754-1761
        • Baert I.A.
        • Jonkers I.
        • Staes F.
        • Luyten F.P.
        • Truijen S.
        • Verschueren S.M.
        Gait characteristics and lower limb muscle strength in women with early and established knee osteoarthritis.
        Clin. Biomech. (Bristol, Avon). 2013; 28: 40-47
        • Bedson J.
        • Mottram S.
        • Thomas E.
        • Peat G.
        Knee pain and osteoarthritis in the general population: what influences patients to consult?.
        Fam. Pract. 2007; 24: 443-453
        • Bosse I.
        • Oberlander K.D.
        • Savelberg H.H.
        • Meijer K.
        • Bruggemann G.P.
        • Karamanidis K.
        Dynamic stability control in younger and older adults during stair descent.
        Hum. Mov. Sci. 2012; 31: 1560-1570
        • Botolfsen P.
        • Helbostad J.L.
        • Moe-Nilssen R.
        • Wall J.C.
        Reliability and concurrent validity of the expanded timed up-and-go test in older people with impaired mobility.
        Physiother. Res. Int. 2008; 13: 94-106
        • Costigan P.A.
        • Deluzio K.J.
        • Wyss U.P.
        Knee and hip kinetics during normal stair climbing.
        Gait Posture. 2002; 16: 31-37
        • Hicks-Little C.A.
        • Peindl R.D.
        • Hubbard T.J.
        • Scannell B.P.
        • Springer B.D.
        • Odum S.M.
        • et al.
        Lower extremity joint kinematics during stair climbing in knee osteoarthritis.
        Med. Sci. Sports Exerc. 2011; 43: 516-524
        • Hicks-Little C.A.
        • Peindl R.D.
        • Fehring T.K.
        • Odum S.M.
        • Hubbard T.J.
        • Cordova M.L.
        Temporal–spatial gait adaptations during stair ascent and descent in patients with knee osteoarthritis.
        J. Arthroplasty. 2012; 27: 1183-1189
        • Hof A.L.
        The ‘extrapolated center of mass’ concept suggests a simple control of balance in walking.
        Hum. Mov. Sci. 2008; 27: 112-125
        • Hof A.L.
        • van Bockel R.M.
        • Schoppen T.
        • Postema K.
        Control of lateral balance in walking. Experimental findings in normal subjects and above-knee amputees.
        Gait Posture. 2007; 25: 250-258
        • Jevsevar D.S.
        • Riley P.O.
        • Hodge W.A.
        • Krebs D.E.
        Knee kinematics and kinetics during locomotor activities of daily living in subjects with knee arthroplasty and in healthy control subjects.
        Phys. Ther. 1993; 73 (discussion 40–2): 229-239
        • Kaufman K.R.
        • Hughes C.
        • Morrey B.F.
        • Morrey M.
        • An K.N.
        Gait characteristics of patients with knee osteoarthritis.
        J. Biomech. 2001; 34: 907-915
        • Kito N.
        • Shinkoda K.
        • Yamasaki T.
        • Kanemura N.
        • Anan M.
        • Okanishi N.
        • et al.
        Contribution of knee adduction moment impulse to pain and disability in Japanese women with medial knee osteoarthritis.
        in: Clin Biomech (Bristol, Avon). 25. 2010 Elsevier Ltd., England2010: 914-919
        • Kuo A.D.
        • Donelan J.M.
        • Ruina A.
        Energetic consequences of walking like an inverted pendulum: step-to-step transitions.
        Exerc. Sport Sci. Rev. 2005; 33: 88-97
        • Lewek M.D.
        • Rudolph K.S.
        • Snyder-Mackler L.
        Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis.
        J. Orthop. Res. 2004; 22: 110-115
        • Major M.J.
        • Stine R.L.
        • Gard S.A.
        The effects of walking speed and prosthetic ankle adapters on upper extremity dynamics and stability-related parameters in bilateral transtibial amputee gait.
        Gait Posture. 2013; 38: 858-863
        • Marmon A.R.
        • Milcarek B.I.
        • Snyder-Mackler L.
        Associations between knee extensor power and functional performance in patients after total knee arthroplasty and normal controls without knee pain.
        Int. J. Sports Phys. Ther. 2014; 9: 168-178
        • Muraki S.
        • Akune T.
        • Oka H.
        • Ishimoto Y.
        • Nagata K.
        • Yoshida M.
        • et al.
        Incidence and risk factors for radiographic knee osteoarthritis and knee pain in Japanese men and women: a longitudinal population-based cohort study.
        Arthritis Rheum. 2012; 64: 1447-1456
        • Startzell J.K.
        • Owens D.A.
        • Mulfinger L.M.
        • Cavanagh P.R.
        Stair negotiation in older people: a review.
        J. Am. Geriatr. Soc. 2000; 48: 567-580
        • van Dijk G.M.
        • Veenhof C.
        • Spreeuwenberg P.
        • Coene N.
        • Burger B.J.
        • van Schaardenburg D.
        • et al.
        Prognosis of limitations in activities in osteoarthritis of the hip or knee: a 3-year cohort study.
        Arch. Phys. Med. Rehabil. 2010; 91: 58-66
        • Winter D.A.
        Overall principle of lower limb support during stance phase of gait.
        J. Biomech. 1980; 13: 923-927
        • Winter D.A.
        Biomechanics and Motor Control of Human Movement.
        in: David A.W. Wiley, Hoboken, N.J2005
        • Yoshimura N.
        • Muraki S.
        • Oka H.
        • Mabuchi A.
        • En-Yo Y.
        • Yoshida M.
        • et al.
        Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study.
        J. Bone Miner. Metab. 2009; 27: 620-628
        • Zeni Jr., J.A.
        • Snyder-Mackler L.
        Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.
        J. Bone Joint Surg. Am. 2010; 92: 1130-1136