Occupational physical loading tasks and knee osteoarthritis: a review of the evidence. Is increased joint loading detrimental to obese patients with knee osteoarthritis? A secondary data analysis from a randomized trial. Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis Knee joint loading and tibial component loosening. RSA and gait analysis in 45 osteoarthritic patients before and after TKA. Nonrandom evolution of end-stage osteoarthritis of the lower limbs. Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative. Knee pain and joint loading in subjects with osteoarthritis of the knee. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial The relationship between prospectively assessed body weight and physical activity and prevalence of radiological knee osteoarthritis in postmenopausal women. Knee laxity after staircase exercise predicts radiographic disease progression in medial compartment knee osteoarthritis. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. The prevalence and progression of radiographic knee osteoarthritis over 6 years in a population-based cohort of middle-aged subjects Does hand osteoarthritis predict future hip or knee osteoarthritis? Improvement in gait one year after surgery for knee osteoarthrosis: a comparison between high tibial osteotomy and prosthetic replacement in a prospective randomized study. Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee.
UNLABELLED Purpose : To perform a systematic review with best evidence synthesis examining the literature on the relationship between occupational loading tasks and  knee osteoarthritis ( OA ) . METHODS Two data bases were search ed to identify articles published between 1946 and April , 2011 . Eligible studies were those that ( 1 ) included adults reporting on their employment history ; ( 2 ) measured individuals ' exposure to work-related activities with heavy loading in the knee joint ; and ( 3 ) identified presence of knee OA ( determined by X-ray ) , cartilage defects associated with knee OA ( identified by magnetic resonance imaging ) , or joint replacement surgery . RESULTS A total of 32 articles from 31 studies met the inclusion criteria . We found moderate evidence that combined heavy lifting and kneeling is a risk factor for knee OA , with odds ratios ( OR ) varying from 1.8 to 7.9 , and limited evidence for heavy lifting ( OR=1.4 - 7.3 ) , kneeling ( OR=1.5 - 6.9 ) , stair climbing ( OR=1.6 - 5.1 ) , and occupational groups ( OR=1.4 - 4.7 ) as risk factors . When examined by sex , moderate level evidence of knee OA was found in men ; however , the evidence in women was limited . CONCLUSIONS Further high- quality prospect i ve studies are warranted to provide further evidence on the role of occupational loading tasks in knee OA , particularly in women OBJECTIVE To investigate whether increased knee joint loading due to improved ambulatory function and walking speed following weight loss achieved over 16 weeks accelerates symptomatic and structural disease progression over a subsequent 1 year weight maintenance period in an obese population with knee osteoarthritis ( OA ) . METHODS Data from a prospect i ve study of weight loss in obese patients with knee OA ( the CARtilage in obese knee OsteoarThritis ( CAROT ) study ) were used to determine changes in knee joint compressive loadings ( model estimated ) during walking after a successful 16 week weight loss intervention . The participants were divided into ' Unloaders ' ( participants that reduced joint loads ) and ' Loaders ' ( participants that increased joint loads ) . The primary symptomatic outcome was changes in knee symptoms , measured with the Knee injury and Osteoarthritis Outcome Score ( KOOS ) question naire , during a subsequent 52 weeks weight maintenance period . The primary structural outcome was changes in tibiofemoral cartilage loss assessed semi-quantitatively ( Boston Leeds Knee Osteoarthritis Score ( BLOKS ) from MRI after the 52 weight maintenance period . RESULTS 157 participants ( 82 % of the CAROT cohort ) with medial and /or lateral knee OA were classified as Unloaders ( n = 100 ) or Loaders ( n = 57 ) . The groups showed similar significant changes in symptoms ( group difference : -2.4 KOOS points [ 95 % CI -6.8:1.9 ] ) and cartilage loss ( group difference : -0.06 BLOKS points [ 95 % CI -0.22:0.11 ) after 1 year , with no statistically significant differences between Loaders and Unloaders . CONCLUSION For obese patients undergoing a significant weight loss , increased knee joint loading for 1 year was not associated with accelerated symptomatic and structural disease progression compared to a similar weight loss group that had reduced ambulatory compressive knee joint loads . CLINICAL TRIALSGOV NCT00655941 Objective Mechanical factors , in particular increased medial knee joint load , are believed to be important in the structural progression of knee osteoarthritis . This study evaluated the relationship of medial knee load during walking to indices of structural disease progression , measured on MRI , in people with medial knee osteoarthritis . Methods A longitudinal cohort design utilising a subset of participants ( n=144 , 72 % ) enrolled in a r and omised controlled trial of lateral wedge insoles was employed .  Medial knee load parameters including the peak knee adduction moment ( KAM ) and the KAM impulse  were measured at baseline using three-dimensional gait analysis during walking . MRI at baseline and at 12 months was used to assess structural indices . Multiple regression with adjustment for covariates assessed the relationship between medial knee load parameters and the annual change in medial tibial cartilage volume . Binary logistic regression was used for the dichotomous variables of progression of medial tibiofemoral cartilage defects and bone marrow lesions ( BML ) . Results A higher KAM impulse , but not peak KAM , at baseline was independently associated with greater loss of medial tibial cartilage volume over 12 months ( β=29.9 , 95 % CI 6.3 to 53.5 , p=0.01 ) . No significant relationships were seen between medial knee load parameters and the progression of medial tibiofemoral cartilage defects or BML . Conclusion This study suggests knee loading , in particular the KAM impulse , may be a risk factor for loss of medial tibial cartilage volume . As knee load is modifiable , load-modifying treatments may potentially slow disease progression We report a prospect i ve study of gait and tibial component migration  in 45 patients with osteoarthritis treated by total knee arthroplasty ( TKA ) .  Migration  was measured over two years using roentgen stereophotogrammetry . We used the previously established threshold of 200 microm migration in the second postoperative year to distinguish two groups : a risk group of 15 patients and a stable group of 28 patients . We performed  gait analysis before operation and at six months and at two years after TKA . On all three occasions we found significant differences between the two groups in the mean sagittal plane moments of the knee joint . The risk group walked with higher peak flexion moments than the stable group . The two groups were not discriminated by any clinical or radiological criteria or other gait characteristics . The relationship which we have found between gait with increased flexion moments and risk of tibial component loosening warrants further study as regards the aetiology of prosthetic loosening and possible methods of influencing its incidence OBJECTIVE Patients with unilateral hip or knee replacements for end-stage osteoarthritis ( OA ) are at high risk for future progression of OA in other joints of the lower extremities , often requiring additional joint replacements . Although the risks of future surgery in the contralateral cognate joints ( i.e. , contralateral hip replacement after an initial hip replacement ) have been evaluated , the evolution of end-stage hip OA to OA involving the knee joints , and vice versa ( i.e. , noncognate progression ) has not been investigated . Because characterization of OA progression in noncognate joints may shed light on the pathogenesis of multijoint OA , we investigated the pattern of evolution of end-stage lower extremity OA in a large , clinical cohort . METHODS Total joint replacement ( TJR ) was selected as a marker of end-stage OA , and a data base comprising all lower extremity TJRs performed at a large referral center between 1981 and 2001 was accessed . Of the 5,894 patients identified , 486 patients with idiopathic OA who underwent hip replacement and 414 who underwent initial knee replacement  were analyzed to determine the relative likelihood of subsequent TJRs .  Patients with the systemic inflammatory arthropathy , rheumatoid arthritis ( RA ) , were evaluated as a control population because RA progression is not considered to be a primarily mechanically mediated process . RESULTS The contralateral cognate joint was the most common second joint to undergo replacement in both the OA and the RA groups . However , in OA patients for whom the second TJR was in a noncognate joint , that joint was > 2-fold more likely to be on the contralateral limb than on the ipsilateral limb ( hip to knee P < 0.001 ; knee to hip P = 0.013 ) . In contrast , among the RA cohort , the evolution was r and om and no laterality for noncognate TJR was observed at either the hip or the knee ( P = 0.782 ) . CONCLUSION This characterization of end-stage lower extremity OA demonstrates that the disease evolves nonr and omly ; after 1 joint is replaced , the contralateral limb is significantly more likely to show progression of OA than is the ipsilateral limb . Thus , OA in 1 weight-bearing joint appears to influence the evolution of OA in other joints . The absence of such laterality in RA suggests that OA progression may be mediated by extrinsic factors such as altered joint loading OBJECTIVES To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis ( OA ) . DESIGN Prospect i ve cohort study of knee OA development and progression with 1-year follow-up . SETTING Community . PARTICIPANTS Osteoarthritis Initiative public data on adults with knee OA ( n=2274 ; age , 45 - 79y ) who participated in functional performance assessment s ( timed 20-m walk and chair st and test ) at baseline and 1-year follow-up . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURE A good 1-year performance outcome ( separately defined for walk time and chair st and measures ) was improvement from baseline quintile or maintenance in the best quintile . RESULTS Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year .  Physical activity  measured by the  Physical Activity Scale for the Elderly  ( PASE ) was significantly associated with good walk rate and chair st and outcomes ( odds ratio per 40 units PASE [ 95 % confidence interval]=1.13 [ 1.13 , 1.17 ] and 1.10 [ 1.05 , 1.15 ] , respectively ) , as were participation in sports/recreational activities ( 1.45 [ 1.23 , 1.71 ] and 1.29 [ 1.09 , 1.51 ] , respectively ) and lifestyle activities ( 1.11 [ 1.06 , 1.16 ] and 1.09 [ 1.04 , 1.14 ] , respectively ) . An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors . Older adults reported the least baseline physical activity and least frequent good 1-year outcomes . CONCLUSIONS These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA .  Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance Although treatments for osteoarthritis of the knee are often directed at relieving pain , pain may cause patients to alter how they perform activities to decrease the loads on the joints . The knee-adduction moment is a major determinant of the load distribution between the medial and lateral plateaus . Therefore , the interrelationship between pain and the external knee-adduction moment during walking may be especially important for underst and ing mechanical factors related to the progression of medial tibiofemoral osteoarthritis . Fifty-three subjects with symptomatic radiographic evidence of osteoarthritis of the knee were studied . These subjects were a subset of those enrolled in a double-blind study in which  gait analysis and radiographic and clinical evaluations were performed after a 2-week washout of anti-inflammatory and analgesic treatment . The subjects then took a nonsteroidal anti-inflammatory drug , acetaminophen , or placebo for 2 weeks , and the gait and clinical evaluations were repeated . The change in the peak external adduction moment between the two evaluations was inversely correlated with the change in pain ( R = 0.48 , p < 0.001 ) and was significantly different between those whose pain increased ( n = 7 ) , decreased ( n = 18 ) , or remained unchanged ( n = 28 ) ( p = 0.009 ) . Those with increased pain had a significant decrease in the peak external adduction ( p = 0.005 ) and flexion moments ( p = 0.023 ) . In contrast , the subjects with decreased pain tended to have an increase in the peak external adduction moment ( p = 0.095 ) and had a significant increase in the peak external extension moment ( p = 0.017 ) . The subjects whose pain was unchanged had no significant change in the peak external adduction ( p = 0.757 ) , flexion ( p = 0.234 ) , or extension ( p = 0.465 ) moments . Thus , decreases in pain among patients with medial tibiofemoral osteoarthritis were related to increased loading of the degenerative portion of the joints . Additional long-term prospect i ve studies are needed to determine whether increased loading during walking actually results in accelerated progression of the disease CONTEXT Knee osteoarthritis ( OA ) is a leading cause of disability in older persons . Few risk factors for disease progression or functional decline have been identified . Hip-knee-ankle alignment influences load distribution at the knee ; varus and valgus alignment increase medial and lateral load , respectively . OBJECTIVE To test the hypotheses that ( 1 ) varus alignment increases risk of medial knee OA progression during the subsequent 18 months , ( 2 ) valgus alignment increases risk of subsequent lateral knee OA progression , ( 3 ) greater severity of malalignment is associated with greater subsequent loss of joint space , and ( 4 ) greater burden of malalignment is associated with greater subsequent decline in physical function . DESIGN AND SETTING Prospect i ve longitudinal cohort study conducted March 1997 to March 2000 at an academic medical center in Chicago , Ill. PARTICIPANTS A total of 237 persons recruited from the community with primary knee OA , defined by presence of definite tibiofemoral osteophytes and at least some difficulty with knee-requiring activity ; 230 ( 97 % ) completed the study . MAIN OUTCOME MEASURES Progression of OA , defined as a 1- grade increase in severity of joint space narrowing on semiflexed , fluoroscopically confirmed knee radiographs ; change in narrowest joint space width ; and change in physical function between baseline and 18 months , compared by knee alignment at baseline . RESULTS Varus alignment at baseline was associated with a 4-fold increase in the odds of medial progression , adjusting for age , sex , and body mass index ( adjusted odds ratio [ OR ] , 4.09 ; 95 % confidence interval [ CI ] , 2.20 - 7.62 ) . Valgus alignment at baseline was associated with a nearly 5-fold increase in the odds of lateral progression ( adjusted OR , 4.89 ; 95 % CI , 2.13 - 11.20 ) . Severity of varus correlated with greater medial joint space loss during the subsequent 18 months ( R = 0.52 ; 95 % CI , 0.40 - 0.62 in dominant knees ) , and severity of valgus correlated with greater subsequent lateral joint space loss ( R = 0.35 ; 95 % CI , 0.21 - 0.47 in dominant knees ) . Having alignment of more than 5 degrees ( in either direction ) in both knees at baseline was associated with significantly greater functional deterioration during the 18 months than having alignment of 5 degrees or less in both knees , after adjusting for age , sex , body mass index , and pain . CONCLUSION This is , to our knowledge , the first demonstration that in primary knee OA varus alignment increases risk of medial OA progression , that valgus alignment increases risk of lateral OA progression , that burden of malalignment predicts decline in physical function , and that these effects can be detected after as little as 18 months of observation Background : Knee osteoarthritis ( OA ) is the most common musculoskeletal disease among old individuals which affects ability for sitting on the chair , st and ing , walking and climbing stairs . Our objective was to investigate the short and long-term effects of the most simple and the least expensive exercise protocol s in combination to conventional conservative therapy for knee OA . Methods : It was a single blind RCT study with a 12-months follow-up . Totally , 56 patients with knee OA were assigned into 2 r and om groups . The patients in exercise group received exercise for knee muscles in combination with non-steroid anti-inflammatory drugs ( NSAIDs ) and 10 sessions acupuncture and physiotherapy modalities . Non-exercise group received similar treatments except exercise program . The changes in patients ’ pain and functional status were evaluated by visual analog scale ( VAS ) , knee and osteoarthritis outcome score ( KOOS ) question naire and functional tests ( 4 steps , 5 sit up , and 6 min walk test ) before and after treatment ( 1 and 3 months after intervention ) , and 1 year later at the follow-up . Results : The results showed that the patients with knee OA in exercise group had significant improvement in pain , disability , walking , stair climbing , and sit up speed after treatment at first and second follow-up when compared with their initial status and when compared with non-exercise group . At third follow up ( 1 year later ) there was significant difference between groups in VAS and in three items of KOOS question naire in functional status . Conclusion : Non aerobic exercises for muscles around knee can augment the effect of other therapeutic interventions like medical therapy , acupuncture , and modalities for knee OA Background Osteoarthritis ( OA ) of the knee is one of the leading causes of disability in the United States . One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies , as they can be used to increase physical activity and promote exercise , which are key components of knee OA management . Objective Currently , no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available , and similarly , no data on whether mHealth technologies can impact outcomes are available . Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored , comprehensive management strategy for patients with knee OA . Methods The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor ( thereby both encouraging changes in mobility as well as tracking them ) combined with education about the benefits of walking on patient mobility . The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors . Activity monitors will capture step count estimates and will compare those with patients ’ step goals , calories burned , and distance walked . Patients using the novel smartphone app will be able to enter information on their daily pain , mood , and sleep quality . The relationships among activity and pain , activity and mood , and sleep will be assessed , as will patient satisfaction with and adherence to the mobile app . Results We present information on an upcoming trial that will prospect ively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid . Conclusions We anticipate the results of this study will support the concept that mHealth technologies provide continuous , real-time feedback to patients with OA on their overall level of activity for a more proactive , personalized approach to treatment that may help modify behavior and assist with self-management through treatment support in the form of motivational messages and reminders OBJECTIVE To determine the effect of weight and physical activity on the prevalence of radiological knee osteoarthritis ( OA ) in a cohort of middle-aged women . METHODS The longitudinal phase of the Melbourne Women 's Mid-life Health Project is a population -based prospect i ve study of 438 Australian-born women who have been followed annually over 11 years . Of these women , 257 ( 59 % ) remained in longitudinal assessment at eleventh year of followup , and 224 of these women agreed to undergo radiographs of their knees . Radiographs were scored for features of OA [ osteophytes and joint space narrowing ( JSN ) ] using a vali date d scale , by 2 investigators who were blinded to question naire results . Data were obtained by both self-administered and face-to-face interview question naires . RESULTS The average weight increase over the study period of 11 years was 4 kg ( range -14 to 25 kg ) . Of the 224 women evaluated , 65 ( 29 % ) had knee joint osteophytes and 95 ( 42 % ) had evidence of knee JSN . Current weight and weight at baseline were independent factors associated with a higher prevalence of both osteophytes and JSN in all compartments of the knee . The average amount of physical activity over the 11 years of followup was a significant factor independently associated with an increased prevalence of patellofemoral JSN and approached significance for tibiofemoral osteophytes and total knee JSN . CONCLUSION Our study supports a longterm detrimental effect of weight on the knee joint and suggests the importance of longterm weight maintenance programs in preventing knee OA . The average amount of physical activity was associated with an increased prevalence of some features of knee OA OBJECTIVE To evaluate whether increased laxity of the knee during daily physical activities such as stair climbing is associated with progression of knee joint osteoarthritis ( OA ) . METHODS During the years 2001 - 2003 , 136 patients with bilateral primary medial compartment knee joint OA were enrolled in this prospect i ve study . Baseline data collected were body mass index ( BMI ) , muscle power , radiographic joint space width , mechanical axis on st and ing radiography , and anteroposterior ( AP ) knee laxity before and after physical exercise . After 8 years of followup , 84 patients were reexamined to assess radiographic changes . Radiographic disease progression was defined as progression of > 1 grade on the Kellgren/Lawrence scale . RESULTS AP knee laxity increased significantly after stair climbing . Patients with OA progression and those without progression did not differ significantly in age , sex , baseline quadriceps muscle strength , mechanical axis , joint space width , and AP knee laxity before exercise . The 2 groups of patients did , however , differ significantly in baseline BMI and change in AP knee laxity due to exercise . The risk of progression of knee OA increased 4.15-fold with each millimeter of increase in the change in AP knee laxity due to exercise and 1.24-fold with each point increase in the BMI . CONCLUSION Our results indicate that patients with OA progression have significantly greater changes in knee joint laxity during physical activities and a higher BMI than patients without OA progression . These findings suggest that larger changes in knee laxity during repetitive physical activities and a higher BMI play significant roles in the progression of knee OA OBJECTIVE To determine the relationship between change in body mass and knee-joint moments and forces during walking in overweight and obese older adults with knee osteoarthritis ( OA ) following an 18-month clinical trial of diet and exercise . METHODS Data were obtained from 142 sedentary , overweight , and obese older adults with self-reported disability and radiographic evidence of knee OA who underwent 3-dimensional gait analysis .  Gait kinetic outcome variables included peak knee-joint forces and peak internal knee-joint moments . Mixed regression models were created to predict followup kinetic values , using followup body mass as the primary explanatory variable . Baseline body mass was used as a covariate , and thus followup body mass was a surrogate measure for change in body mass ( i.e. , weight loss ) . RESULTS There was a significant direct association between followup body mass and peak followup values of compressive force ( P = 0.001 ) , result ant force ( P = 0.002 ) , abduction moment ( P = 0.03 ) , and medial rotation moment ( P = 0.02 ) . A weight reduction of 9.8 N ( 1 kg ) was associated with reductions of 40.6 N and 38.7 N in compressive and result ant forces , respectively . Thus , each weight-loss unit was associated with an approximately 4-unit reduction in knee-joint forces . In addition , a reduction in body weight of 9.8 N ( 1 kg ) was associated with a 1.4 % reduction ( 0.496 Nm ) in knee abduction moment . CONCLUSION Our results indicate that each pound of weight lost will result in a 4-fold reduction in the load exerted on the knee per step during daily activities . Accumulated over thous and s of steps per day , a reduction of this magnitude would appear to be clinical ly meaningful Details of the development of early knee osteoarthritis ( OA ) are largely unknown . The prevalence and progression of  radiographic knee OA  over 6 years in middle-aged subjects with chronic knee pain is investigated . In a prospect i ve population -based study , tibiofemoral ( TF ) and patellofemoral ( PF ) radiographs were grade d in 128 subjects ( mean age 45 ± 6.2 years ) for the presence of osteophytes and joint space narrowing ( JSN ) . Radiographic progression was defined as : ( i ) the presence of osteophytes and /or JSN in subjects with no previous OA or ( ii ) an increase in the grade and /or number of already existing osteophytes and /or JSN . Altogether 56 % ( 72/128 ) of subjects had knee OA , the majority of them was diagnosed with OA grade 1 . In 57 % of cases , radiographic OA was based on the presence of osteophytes alone versus 13 % on JSN . More than 1/3 of subjects had isolated PF joint involvement . Knee OA progression rate over 6 years was 56 % ( 71/128 ) . During 6 years , a non-linear course of radiographic OA progression with intermittent periods of progression and stabilization was observed . Individual course of OA revealed distinct subsets of radiographic progression . Osteophytosis is an important early radiographic sign of OA and its progression . Isolated PF joint involvement is a frequent expression of knee OA . In middle-aged subjects , the progression rate of knee OA over 6 years was 56 % . A non-linear course of radiographic OA progression was observed . Several radiographic subsets refer to the heterogeneity of the OA process OBJECTIVE To evaluate the risk of future hip or knee osteoarthritis ( OA ) in subjects with h and OA at baseline and to evaluate whether the concurrent presence of h and OA , other risk factors for OA , or an OA biomarker ( type II collagen C-telopeptide degradation product [ CTX-II ] ) further increases the risk . METHODS Radiographs of the h and s ( baseline ) and the hips and knees ( baseline and 6.6 years later ) were obtained in a r and omly selected subset of participants in the Rotterdam Study who were ages 55 years and older . Radiographs were scored for the presence of OA using the Kellgren/Lawrence ( K/L ) system . A total of 1,235 subjects without OA of the hip/knee ( K/L score 0 - 1 ) at baseline were included in the study . CTX-II levels were measured at baseline . The independent risk of future hip/knee OA in subjects with h and OA at baseline was assessed by logistic regression , as stratified for age , sex , body mass index , family history of OA , and heavy workload . RESULTS Overall 12.1 % of the participants ( 19.7 % of those with h and OA versus 10.0 % of those without ) developed hip or knee OA ( odds ratio [ OR ] 2.1 [ 95 % confidence interval ( 95 % CI ) 1.3 - 3.1 ] ) . Subjects with h and OA had an increased risk of future hip OA ( OR 3.0 [ 95 % CI 1.6 - 5.4 ] ) , which was further increased in those with a family history of OA . Subjects with h and OA had an OR of 1.6 [ 95 % CI 1.0 - 2.8 ) for the future development of knee OA , which was further increased in those who were overweight . Concurrent h and OA and high levels of CTX-II further increased the risk of having hip or knee OA at followup ( OR 4.2 [ 95 % CI 2.3 - 7.8 ] ) . CONCLUSION The presence of h and OA at baseline showed an increased risk of future hip/knee OA ( higher for hip OA than for knee OA ) . The concurrent presence of h and OA and other OA risk factors or high CTX-II levels further increased the risk of future hip/knee OA The aim of this study was to analyse gait improvement one year after high tibial osteotomy and unicompartmental knee arthroplasty in patients with strictly unilateral osteoarthrosis of the medial compartment of the knee . Thirty-six patients , 18 men and 18 women , received a unicompartmental Brigham knee prosthesis and 23 patients , 10 men and 13 women , were operated on with a high tibial osteotomy .  Clinical and radiographical assessment s were supplemented by a functional test , measurements of thigh muscle torque with a Cybex II dynamometer and analysis on a force plate walkway with electrogoniometers . All patients were assessed prior to , and one year after surgery . Both groups showed overall clinical improvement , as assessed by the British Orthopaedic Association ( BOA ) score . Pain during walking decreased . The range of knee flexion remained unchanged . The ability to ascend and descend steps improved . The isokinetic thigh muscle torque remained unchanged . In the prosthetic group free walking speed increased from 1.03 to 1.09 m/s ( p < 0.001 ) . Step frequency and step length increased ( p < 0.001 ) . Single stance phase ratio increased from 0.96 to 0.99 ( p < 0.01 ) , indicating a more symmetrical gait . Double stance phase ( % gait cycle ) of both legs decreased ( p < 0.001 ) , indicating a faster transfer of weight during walking . In the osteotomy group , free walking speed did not increase . Step length of the uninvolved leg increased ( p < 0.01 ) . Double stance phase of the involved leg decreased ( p < 0.001 ) and double stance phase of the uninvolved leg decreased ( p < 0.01 ) . Both groups improved after surgery and there was no difference between the groups . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND AND PURPOSE The knee is the weight-bearing joint most commonly affected by osteoarthritis ( OA ) . The symptoms of pain , morning stiffness of short duration and physical dysfunction in the activities of daily living ( ADL ) can have an effect on many aspects of health , affecting quality of life . Regular and moderate physical activity adapted to individuals ' life-styles and education , and joint protection strategies have been advocated as conservative management . The purpose of the present study was to assess the impact of an exercise and walking protocol on the quality of life of elderly people with knee OA . METHOD The study design was a r and omized controlled clinical trial . The subjects comprised 50 elderly people , aged 65 or more , with knee OA who had been referred to the geriatric outpatient unit for rehabilitation . Changes in severity of pain and quality of life were compared between a control group ( CG ) and an experimental group ( EG ) . Both groups participated in an educational session and the EG also received a 12-week exercise and walking protocol . Both groups were assessed at baseline and after three and six months by an independent observer . The Lequesne Index of Knee OA Severity ( LI ) , the Health Assessment Question naire ( HAQ ) and the Medical Outcomes Short-Form Health Survey ( SF-36 ) were used as measurement instruments . RESULTS In the CG , the measures of quality of life ( SF-36 ) , the HAQ and the LI between subjects did not yield statistically significant differences over the three measurement points . For the EG , there was a significant improvement in function , measured by HAQ , and decreasing OA symptom severity , measured by LI . For the SF-36 there were significant improvements in physical function , functional role limitation and pain . Comparisons between the groups showed statistically significant differences after three and six months for all measures , except for the SF-36 emotional domains . CONCLUSION The exercise protocol and walking programme had a positive effect on the quality of life of elderly individuals with knee OA
There is very limited and low- quality evidence to support for a causal link between knee joint loading during walking and structural progression of knee OA .
OBJECTIVE We performed a systematic review , meta- analysis and assessed the evidence supporting a causal link between knee joint loading during walking and structural knee osteoarthritis ( OA ) progression .