Individual joint contributions to the total support moment during the sit-to-stand task differentiate mild and moderate knee osteoarthritis


      • Those with different degrees of knee osteoarthritis rise from the chair differently.
      • Moderate osteoarthritis presented an intersegmental incoordination at the end of the task.
      • Individuals with moderate osteoarthritis stand up using higher trunk flexion.
      • Individuals with mild/moderate osteoarthritis stand up with lower knee moment in the sagittal plane.



      Knee osteoarthritis tends to modify the kinematics and kinetics of the sit-to-stand task. However, it is not clear whether the different degrees of knee osteoarthritis differentiate regarding these aspects. The objective was to identify if the trunk flexion, lower limb kinetics, total support moment, and individual joint contributions to the total support moment during the sit-to-stand task are different between patients with mild and moderate knee osteoarthritis.


      Sixty-two participants were grouped as follows: moderate knee osteoarthritis (n = 16), mild knee osteoarthritis (n = 25), and controls (n = 21). The participants performed a sit-to-stand task, which was analyzed using a 3D-motion system and a force plate.


      The three phases of the sit-to-stand task were analyzed. During Phase1, the moderate osteoarthritis group decreased the total support moment (P = 0.012). During Phase2, the moderate osteoarthritis group showed higher trunk flexion (P = 0.023) and lower internal hip and knee extension moments (P ≤ 0.001 and P ≤ 0.040, respectively) when compared to controls. Also in Phase2, both the mild and moderate groups used lower total support moment (P = 0.019, and P ≤ 0.001, respectively). When compared to the controls and mild osteoarthritis group, those with moderate osteoarthritis presented higher hip joint contribution to the total support moment (P ≤ 0.001 and P = 0.006, respectively) as well as lower knee joint contribution (P ≤ 0.003 and P = 0,013, respectively).


      Those with moderate osteoarthritis showed modified sit-to-stand movement pattern. While in Phase3 a higher contribution of the hip joint to the total support moment was observed, during previous phases the individuals were able to decrease the load on the knee without influencing the lower limb load distribution.


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        • Alnahdi A.H.
        • Zeni J.A.
        • Snyder-Mackler L.
        Muscle impairments in patients with knee osteoarthritis.
        Sports Health. 2012; 4: 284-292
        • Altman R.
        • Asch E.
        • Bloch D.
        • Bole G.
        • Borenstein D.
        • Brandt K.
        • Christy W.
        • Cooke T.
        • Greenwald R.
        • Hochberg M.
        Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee.
        Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986; 29: 1039-1049
        • Anan M.
        • Shinkoda K.
        • Suzuki K.
        • Yagi M.
        • Ibara T.
        • Kito N.
        Do patients with knee osteoarthritis perform sit-to-stand motion efficiently?.
        Gait Posture. 2015; 41: 488-492
        • Bell A.L.
        • Brand R.A.
        • Pedersen DR.
        Prediction of hip joint centre location from external landmarks.
        Hum. Mov. Sci. 1989; 8: 3-16
        • Bellamy N.
        • Buchanan W.W.
        • Goldsmith C.H.
        • Campbell J.
        • Stitt L.W.
        Validation-study of WOMAC - a health-status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug-therapy in patients with osteoarthritis of the hip or knee.
        J. Rheumatol. 1988; 15: 1833-1840
        • Blackburn J.T.
        • Padua D.A.
        Sagittal-plane trunk position, landing forces, and quadriceps electromyographic activity.
        J. Athl. Train. 2009; 44: 174-179
        • Bouchouras G.
        • Patsika G.
        • Hatzitaki V.
        • Kellis E.
        Kinematics and knee muscle activation during sit-to-stand movement in women with knee osteoarthritis.
        Clin. Biomech. 2015; 30: 599-607
        • Chapman G.J.
        • Parkes M.J.
        • Forsythe L.
        • Felson D.T.
        • Jones R.K.
        Ankle motion influences the external knee adduction moment and may predict who will respond to lateral wedge insoles?: an ancillary analysis from the SILK trial.
        Osteoarthr. Cartil. 2015; 23: 1316-1322
        • Christiansen C.L.
        • Bade M.J.
        • Judd D.L.
        • Stevens-Lapsley J.E.
        Weight-bearing asymmetry during sit-stand transitions related to impairment and functional mobility after total knee arthroplasty.
        Arch. Phys. Med. Rehabil. 2011; 92: 1624-1629
        • Dall P.M.
        • Kerr A.
        Frequency of the sit to stand task: an observational study of free-living adults.
        Appl. Ergon. 2010; 41: 58-61
        • Doorenbosch C.A.M.
        • Harlaar J.
        • Roebroeck M.E.
        • Lankhorst J.
        Two strategies of transferring from sit-to-stand; the activation of monoarticular and biarticular muscles.
        J. Biomech. 1994; 27: 1299-1307
        • Duffell L.D.
        • Gulati V.
        • Southgate D.F.L.
        • McGregor A.H.
        Measuring body weight distribution during sit-to-stand in patients with early knee osteoarthritis.
        Gait Posture. 2013; 38: 745-750
        • Farquhar S.J.
        • Reisman D.S.
        • Snyder-Mackler L.
        Persistence of altered movement patterns during a sit-to-stand task 1 year following unilateral total knee arthroplasty.
        Phys. Ther. 2008; 88: 567-579
        • Farrokhi S.
        • Pollard C.D.
        • Souza R.B.
        • Chen Y.-J.
        • Reischl S.
        • Powers C.M.
        Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise.
        J. Orthop. Sport. Phys. Ther. 2008; 38: 403-409
        • Farrokhi S.
        • Chen Y.-F.
        • Piva S.R.
        • Fitzgerald G.K.
        • Jeong J.-H.
        • Kwoh C.K.
        The influence of knee pain location on symptoms, functional status, and knee-related quality of life in older adults with chronic knee pain: data from the osteoarthritis initiative.
        Clin. J. Pain. 2016; 32: 463-470
        • Flanagan S.P.
        • Salem G.P.
        The validity of summing lower extremity individual joint kinetic measures.
        J. Appl. Biomech. 2005; 21: 181-188
        • Gonçalves G.H.
        • Selistre L.F.A.
        • Petrella M.
        • Mattiello S.M.
        Kinematic alterations of the lower limbs and pelvis during an ascending stairs task are associated with the degree of knee osteoarthritis severity.
        Knee. 2017; 24: 295-304
        • Gonçalves G.H.
        • Sendín F.A.
        • da Silva Serrão P.R.M.
        • Selistre L.F.A.
        • Petrella M.
        • Carvalho C.
        • Mattiello S.M.
        Ankle strength impairments associated with knee osteoarthritis.
        Clin. Biomech. 2017; 46: 33-39
        • Hof A.L.
        On the interpretation of the support moment.
        Gait Posture. 2000; 12: 196-199
        • Kawagoe S.
        • Tajima N.
        • Chosa E.
        Biomechanical analysis of effects of foot placement with varying chair height on the motion of standing up.
        J. Orthop. Sci. 2000; 5: 124-133
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann. Rheum. Dis. 1957; 16: 494-502
        • Khemlani M.M.
        • Carr J.H.
        • Crosbie W.J.
        Muscle synergies and joint linkages in sit-to-stand under two initial foot positions.
        Clin. Biomech. 1999; 14: 236-246
        • Kuznetsov N.A.
        • Riley M.A.
        The role of task constraints in relating laboratory and clinical measures of balance.
        Gait Posture. 2015; 42: 275-279
        • McAlindon T.E.
        • Bannuru R.R.
        • Sullivan M.C.
        • Arden N.K.
        • Berenbaum F.
        • Bierma-Zeinstra S.M.
        • Hawker G.A.
        • Henrotin Y.
        • Hunter D.J.
        • Kawaguchi H.
        • Kwoh K.
        • Lohmander S.
        • Rannou F.
        • Roos E.M.
        • Underwood M.
        OARSI guidelines for the non-surgical management of knee osteoarthritis.
        Osteoarthr. Cartil. 2014; 22: 363-388
        • Metcalfe A.J.
        • Andersson M.L.E.
        • Goodfellow R.
        • Thorstensson C.A.
        Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study.
        BMC Musculoskelet. Disord. 2012; 13153
        • Mizner R.L.
        • Snyder-Mackler L.
        Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty.
        J. Orthop. Res. 2005; 23: 1083-1090
        • Pai Y.C.
        • Chang H.J.
        • Chang R.W.
        • Sinacore J.M.
        • Lewis J.L.
        Alteration in multijoint dynamics in patients with bilateral knee osteoarthritis.
        Arthritis Rheum. 1994; 37: 1297-1304
        • Palmieri-Smith R.M.
        • Thomas A.C.
        • Karvonen-Gutierrez C.
        • Sowers M.F.
        Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis.
        Am. J. Phys. Med. Rehabil. 2010; 89: 541-548
        • Sagawa Y.
        • Bonnefoy-Mazure A.
        • Armand S.
        • Hoffmeyer P.
        • Suva D.
        • Turcot K.
        Individuals with knee osteoarthritis exhibit altered movement patterns during the sts task.
        Mov. Sport Sci. 2017; 98: 39-49
        • Sagawa Y.
        • Bonnefoy-Mazure A.
        • Armand S.
        • Lubbeke A.
        • Hoffmeyer P.
        • Suva D.
        • Turcot K.
        Variable compensation during the sit-to-stand task among individuals with severe knee osteoarthritis.
        Ann. Phys. Rehabil. Med. 2017; 60: 312-318
        • Samaan M.A.
        • Schwaiger B.J.
        • Gallo M.C.
        • Link T.M.
        • Zhang A.L.
        • Majumdar S.
        • Souza R.B.
        Abnormal joint moment distributions and functional performance during sit-to-stand in femoroacetabular impingement patients.
        PM&R. 2017; 9: 563-570
        • Santos M.L.A.S.
        • Gomes W.F.
        • Pereira D.S.
        • Oliveira D.M.G.
        • Dias J.M.D.
        • Ferrioli E.
        • Pereira L.S.M.
        Muscle strength, muscle balance, physical function and plasma interleukin-6 (IL-6) levels in elderly women with knee osteoarthritis (OA).
        Arch. Gerontol. Geriatr. 2011; 52: 322-326
        • Schenkman M.
        • Berger R.A.
        • Riley P.O.
        • Mann R.W.
        • Hodge W.A.
        • Rlley P.
        • Mann R.W.
        Whole-body movements during rising to standing from sitting.
        Phys. Ther. 1990; 70: 638-648
        • Selistre L.F.A.
        • Mattiello S.M.
        • Nakagawa T.H.
        • Gonçalves G.H.
        • Petrella M.
        • Jones R.K.
        The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis.
        J. Electromyogr. Kinesiol. 2017; 33: 64-72
        • Serrão P.R.M.S.
        • Vasilceac F.A.
        • Gramani-Say K.
        • Lessi G.C.
        • Oliveira A.B.
        • Reiff R.B.M.
        • Mattiello-Sverzut A.C.
        • Mattiello S.M.
        Men with early degrees of knee osteoarthritis present functional and morphological impairments of the quadriceps femoris muscle.
        Am. J. Phys. Med. Rehabil. 2014; 94: 70-81
        • Su F.C.
        • Lai K.A.
        • Hong W.H.
        Rising from chair after total knee arthroplasty.
        Clin. Biomech. 1998; 13: 176-181
        • Turcot K.
        • Armand S.
        • Fritschy D.
        • Hoffmeyer P.
        • Suvà D.
        Sit-to-stand alterations in advanced knee osteoarthritis.
        Gait Posture. 2012; 36: 68-72
        • Wesseling J.
        • Bierma-Zeinstra S.M.A.
        • Kloppenburg M.
        • Meijer R.
        • Bijlsma J.W.J.
        Worsening of pain and function over 5 years in individuals with ‘early’ OA is related to structural damage: data from the osteoarthritis initiative and CHECK (Cohort Hip & Cohort Knee) study.
        Ann. Rheum. Dis. 2015; 74: 347-353
        • Wilson R.
        • Blakely T.
        • Abbott J.H.
        Radiographic knee osteoarthritis impacts multiple dimensions of health-related quality of life: data from the osteoarthritis initiative.
        Rheumatology. 2018; 57: 891-899
        • Winter D.A.
        Overall principle of lower limb support during stance phase of gait.
        J. Biomech. 1980; 13: 923-927
        • Winter D.
        Biomechanics and Motor Control of Human Movement.
        Wiley, New York2009
        • Wu G.
        • Siegler S.
        • Allard P.
        • Kirtley C.
        • Leardini A.
        • Rosenbaum D.
        • Whittle M.
        • D’Lima D.D.
        • Cristofolini L.
        • Witte H.
        • Schmid O.
        • Stokes I.
        ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine.
        J. Biomech. 2002; 35: 543-548
        • Yu B.
        • Holly-Crichlow N.
        • Brichta P.
        • Reeves G.R.
        • Zablotny C.M.
        • Nawoczenski D.A.
        The effects of the lower extremity joint motions on the total body motion in sit-to-stand movement.
        Clin. Biomech. 2000; 15: 449-455
        • Zeni J.A.
        • Higginson J.S.
        Knee osteoarthritis affects the distribution of joint moments during gait.
        Knee. 2011; 18: 156-159