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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 169-172

Comparison of gait biomechanics in patients with and without knee osteoarthritis during different phases of gait cycle


MYAS - GNDU Department of Sports Sciences and Medicine, Guru Nanak Dev University, Amritsar, Punjab, India

Date of Submission06-Mar-2020
Date of Decision18-May-2020
Date of Acceptance25-May-2020
Date of Web Publication18-Dec-2020

Correspondence Address:
Dr. Amrinder Singh
MYAS - GNDU Department of Sports Sciences and Medicine, Guru Nanak Dev University, Amritsar, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_19_20

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  Abstract 


OBJECTIVE: The aim of this study was to investigate the differences in temporal and spatial parameters in patients with and without knee osteoarthritis (OA) during different phases of gait cycle.
MATERIALS AND METHODS: In this study, two groups were taken, OA group and healthy group. OA group consisted of 25 females suffering from knee OA (mean age 60.04 ± 5.74 years; mean height 150.44 ± 5.88 cm; mean weight 63.76 ± 7.28 kg), and healthy group consisted of 25 females (mean age 50.56 ± 7.03 years; mean height 155.16 ± 4.08 cm; mean weight 61.77 ± 12.03 kg). Both OA and healthy groups were assessed for temporal and spatial gait parameters by Zebris FDM Treadmill analysis system.
RESULTS: Mann–Whitney U-test was used to compare the results of the study groups. Significant differences were found in the following variables – left stance phase (%), right stance phase (%), right load response (%), right mid stance (%), right preswing (%), left swing phase (%), right swing phase(%), double stance (%), right and left foot rotation (degrees), and cadence (steps/min).
CONCLUSION: The spatial and temporal differences between patients with knee OA and healthy elderly females suggest that patients with knee OA adopt different strategies to reduce impact on knees. Gait dysfunction can be evaluated by assessing the various gait parameters, and treatment progression can be done in patients with knee OA. The assessment of gait by Zebris FDM Treadmill analysis system is a simple way which is done objectively.

Keywords: Gait, knee osteoarthritis, spatial parameters, temporal


How to cite this article:
Singh A, Kaur R, Shenoy S, Sandhu JS. Comparison of gait biomechanics in patients with and without knee osteoarthritis during different phases of gait cycle. BLDE Univ J Health Sci 2020;5:169-72

How to cite this URL:
Singh A, Kaur R, Shenoy S, Sandhu JS. Comparison of gait biomechanics in patients with and without knee osteoarthritis during different phases of gait cycle. BLDE Univ J Health Sci [serial online] 2020 [cited 2021 Apr 14];5:169-72. Available from: https://www.bldeujournalhs.in/text.asp?2020/5/2/169/303960



Osteoarthritis (OA) is a type of degenerative disorder of the joint. Primary OA due to wear and tear of cartilage or aging is one of the leading causes of disability in the US and worldwide.[1] It is the one of the most important causes of disability in hip and knee joint.[2] It ranks fifth worldwide among all form of disabilities.[3] It is the most prevalent musculoskeletal pathology, affecting almost 10% population of the world.[4] The prevalence of OA increases with age; it is common in people over 60 years of age in high-income countries.[5] It is estimated that OA will affect 130 million people in the world by 2050.[6] Pathophysiology of OA is still poorly understood. Various factors responsible for the development of OA are obesity, family history, aging, synovitis, systemic inflammatory mediators, malalignment of lower limb (genu varum and valgum), joint shape, dysplasia, previous damage to joint such as meniscectomy, injury to anterior cruciate ligament, and proprioceptive deficit.[7],[8],[9],[10],[11],[12],[13] Important factors responsible for the development of OA in knee in females are changes in anatomy and kinematics.

knee OA affects kinetics, kinematics and various gait phase, spatial and temporal parameters.[14],[15],[16],[17],[18] Gait analysis is an important tool to observe various changes in the temporal and spatial parameters of gait. It is an important tool which helps in assessing the various deviations and abnormalities in gait cycle, which leads to the development of knee OA. Various changes can be observed in the gait cycle of patients with knee OA. Patient with knee OA walks at lower speed as compared to healthy individuals for giving less impact over the knee joint.[19]

Although many studies have been conducted on detailed examination of kinetic and kinematic changes in the patients with knee OA, ( there is very less literature available regarding changes in various gait phase, spatial and temporal parameters in patient with knee OA in comparison to healthy individuals. Some studies have been conducted using few gait parameters. Huang and Brown, in their study, showed that there are no differences between knee OA and healthy patients in cadence, velocity, and double support phase duration.[20] In present study, detailed investigation of all gait phase parameters, temporal and spatial parameters was done.


  Materials and Methods Top


Study design

This was an observational study.

In this study, two groups were taken, OA group and healthy group. OA group consisted of 25 females suffering from knee OA (mean age 60.04 ± 5.74 years; mean height 150.44 ± 5.88 cm; and mean weight 63.76 ± 7.28 kg), and healthy group consisted of 25 females (mean age 50.56 ± 7.03 years; mean height 155.16 ± 4.08 cm; and mean weight 61.77 ± 12.03 kg). Both groups were assessed for gait parameters by Zebris FDM Treadmill analysis system. The procedure and purpose of the study were fully explained to the subjects before the test was started, and duly informed consent was taken. This study was approved by Institutional Ethics Committee, Guru Nanak Dev University (GNDU), Amritsar. Data were collected according to the inclusion and exclusion criteria. Patients were selected according to The European League Against Rheumatism who recommended the use of three symptoms (persistent pain, limited morning stiffness, and reduced function) and three signs (crepitus, restricted range of motion, and bony enlargement) for making the diagnosis of knee OA.[21] Inclusion criteria include patients with OA of knee (age >45 years) and healthy females of the same age group. Subjects having any history of fracture of lower limb, cardiac or respiratory disorder, metabolic disorder, systemic disorder, neurological disorder, and any recent hip, knee, and ankle surgery were excluded from the study. The procedure was performed using the Zebris FDM Treadmill analysis system. Subjects were made to walk barefoot on a self-selected speed on the treadmill. The various parameters of gait including gait phase parameters, spatial and temporal parameters were assessed.

Statistical analysis

All data were expressed as mean, standard deviation, and interquartile range. Mann–Whitney U-test was applied for the comparison of the data. The data were analyzed for statistical significance using the Statistical Package for the Social Sciences (23.0) software (SPSS IBM, Illinois, Chicago, USA). A P < 0.05 was considered statistical significant.


  Results Top


In present study, comparison of gait phase, spatial and temporal parameters in patients with knee Osteoarthritis and healthy females was done as per software available in Zebris FDM treadmill system. Various parameters which were analysed includes left stance phase (%), right stance phase (%), stance phase difference (%), left load response (%), right load response (%), load response difference (%), left mid stance (%), right mid stance (%), mid stance difference (%), left preswing (%), right preswing (%), preswing difference (%), left swing phase (%), right swing phase(%), swing phase difference (%), double stance (%), left and right foot rotation degrees, left step length (cm), right step length (cm). step length difference (cm), stride length (cm), step width (cm), velocity (km/h), left step time (seconds), right step time (seconds), step time difference (seconds), stride time (seconds) and cadence (steps/min).

For statistical analysis of the data, Mann–Whitney U-test was used to compare the results of the study groups. Significant differences were found in the following variables – left stance phase (%), right stance phase (%), right load response (%), right mid stance (%), right preswing (%), left swing phase (%), right swing phase(%), double stance (%), right and left foot rotation (degrees), and cadence (steps/min). The results of all the parameters has been represented in [Table 1] and [Table 2].
Table 1: The gait phase parameters in patients with knee osteoarthritis and control group

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Table 2: The spatial and temporal parameters in patients with knee osteoarthritis and control group

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  Discussion Top


The purpose of this study was to add new information regarding the changes in various gait phase, spatial and temporal parameters of gait cycle in females having knee OA as compared to healthy females of same age group. Various gait phase, spatial and temporal parameters of gait cycle were assessed. Significant differences were found in the following parameters: left stance phase (%), right stance phase (%), right load response (%), right mid stance (%), right preswing (%), left swing phase (%), right swing phase (%), double stance (%), right and left foot rotation (degrees), and cadence (steps/min). Patients with OA showed various changes in the gait cycle parameters. They showed reduction in stance phase percentage as compared to healthy group. A possible explanation for these changes might relate to the nature of disease. By reducing stance phase percentage, the patient can reduce the impact on knee which further can help in reducing pain. We also found significant difference in the right load response and right mid stance phase percentage; the possible reason for the same could be that all the patients in this study were right side dominant. Load response and mid stance are reduced in case of OA patients as compared to healthy patients because patients with knee OA attempt to reduce pain by minimizing the impact on their knees. Patients with knee OA mostly have genu varum deformity; this could be the one of the reasons that we found significant differences in the right and left foot rotation degrees. Significant differences were also found in the right and left swing phase percentage and cadence as patients with knee OA try to maintain balance and stabilization by adopting various strategies to prevent the risk of fall.

There is very less literature available in context to compare the gait parameters in OA patients and elderly healthy females. The present study was in accordance to Debi et al., who had studied the differences in gait patterns, pain, function, and quality of life between males and females with knee OA.[22] There is lack of studies which compare the changes in various temporal and spatial gait parameters in OA and healthy elderly Indian females. In the present study, this comparative study is done. Reed, 2013 in their findings provided clinicians and researchers with an indication of the repeatability and sensitivity of the Zebris FDM Treadmill system to detect changes in various spatiotemporal gait parameters and vertical ground reaction forces.[23] This can be a possible reason for the significant findings in our study as the same equipment has been used in the present study.


  Conclusion Top


Significant differences are found in most of the gait phase parameters. Patients with knee OA walk at a slower self-selected speed and exhibit greater gait asymmetry. Various temporal and spatial differences suggest that patient with knee OA adopts different strategies to reduce impact on knee. Above readings can be used as a way of evaluating gait asymmetry and monitoring treatment progress in individual with knee OA. The overall findings of this study imply that the measurement of various temporal and spatial parameters of gait cycle is sensitive to knee OA and this can be used for the evaluation of gait in patients with knee OA. Gait analysis provides the information to understand the role of gait biomechanics in the development of knee OA and to design the therapeutic intervention.

Financial support and sponsorship

The set up for the research work was organized by the MYAS – GNDU, Department of Sports Sciences and Medicine, GNDU, Amritsar, Punjab.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chu CR, Millis MB, Olson SA. Osteoarthritis: From Palliation to Prevention: AOA Critical Issues. J Bone Joint Surg Am 2014;96:e130.  Back to cited text no. 1
    
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Grazio S, Balen D. Obesity: Risk factor and predictor of osteoarthritis. Lijec Vjesn 2009;131:22-6.  Back to cited text no. 2
    
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Murray CJ, Lopez AD. Regional patterns of disability-free life expectancy and disability-adjusted life expectancy: Global burden of disease study. Lancet 1997;349:1347-52.  Back to cited text no. 3
    
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Pereira D, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: A systematic review. Osteoarthritis Cartilage 2011;19:1270-85.  Back to cited text no. 4
    
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Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG. et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis 2013;72:1125-35.  Back to cited text no. 5
    
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Chahla J, Piuzzi NS, Mitchell JJ, Dean CS, Pascual-Garrido C, LaPrade RF, et al. Intra-articular cellular therapy for osteoarthritis and focal cartilage defects of the knee: A systematic review of the literature and study quality analysis. J Bone Joint Surg Am 2016;98:1511-21.  Back to cited text no. 7
    
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Arden N, Nevitt M. Osteoarthritis: Epidemiology. Best Pract Res Clin Rheumatol 2006;20:3-25.  Back to cited text no. 8
    
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Wluka AE, Lombard CB, Cicuttini FM. Tackling obesity in knee osteoarthritis. Nat Rev Rheumatol 2013;9:225-35.  Back to cited text no. 9
    
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Duivenvoorden T, Brouwer RW, Raaij TM, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev 2015;(3):CD004020.  Back to cited text no. 10
    
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Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med 2016;44:792-800.  Back to cited text no. 11
    
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Piuzzi NS, Slullitel PA, Bertona A, Oñativia IJ, Albergo I, Zanotti G, et al. Hip arthroscopy in osteoarthritis: A systematic review of the literature. Hip Int 2016;26:8-14.  Back to cited text no. 12
    
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Childs JD, Sparto PJ, Fitzgerald G, Bizzini M, Irrgang JJ. Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis. Clin Biomech 2004;19:44-9.  Back to cited text no. 14
    
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Gök H, Ergin S, Yavuzer G. Kinetic and kinematic characteristics of gait in patients with medial knee arthrosis. Acta Orthop Scand 2002;73:647-52.  Back to cited text no. 15
    
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Al-Zahrani KS, Bakheit AM. A study of the gait characteristics of patients with chronic osteoarthritis of the knee. Disabil Rehabil 2002;24:275-80.  Back to cited text no. 16
    
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Kaufman KR, Hughes C, Morrey BF, Morrey M, An KN. Gait characteristics of patients with knee osteoarthritis. J Biomech 2001;34:907-15.  Back to cited text no. 17
    
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Rudolph KS, Schmitt LC, Lewek MD. Age-related changes in strength, joint laxity, and walking patterns: Are they related to knee osteoarthritis? Phys Ther 2007;87:1422-32.  Back to cited text no. 18
    
19.
Mündermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: Increased load at the ankle, knee, and hip during walking. Arthritis Rheum 2005;52:2835-44.  Back to cited text no. 19
    
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Huang MH, Brown SH. Age differences in the control of postural stability during reaching tasks. Gait Posture 2013;38:837-42.  Back to cited text no. 20
    
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Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010;18:476-99.  Back to cited text no. 21
    
22.
Debi R, Mor A, Segal O, Segal G, Debbi E, Agar G, et al. Differences in gait patterns, pain, function and quality of life between males and females with knee osteoarthritis: A clinical trial. BMC Musculoskelet Dis 2009;10:127.  Back to cited text no. 22
    
23.
Reed LF, Urry SR, Wearing SC. Reliability of spatiotemporal and kinetic gait parameters determined by a new instrumented treadmill system. BMC Musculoskelet Disord 2013;14:249.  Back to cited text no. 23
    



 
 
    Tables

  [Table 1], [Table 2]



 

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