Van Rossom Sam, Emmerzaal Jill, van der Straaten Rob, Wesseling Mariska, Corten Kristoff, Bellemans Johan, Truijen Jan, Malcorps Jan, Timmermans Annick, Vanwanseele Benedicte, Jonkers Ilse
Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Belgium; Robotics, Automation and Mechatronics, Department of Mechanical Engineering, KU Leuven, Belgium.
Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Belgium; REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.
Clin Biomech (Bristol). 2023 Jan;101:105858. doi: 10.1016/j.clinbiomech.2022.105858. Epub 2022 Dec 9.
Osteoarthritis is a highly prevalent disease affecting the hip and knee joint and is characterized by load-mediated pain and decreased quality of life. Dependent on involved joint, patients present antalgic movement compensations, aiming to decrease loading on the involved joint. However, the associated alterations in mechanical loading of the ipsi- and contra-lateral lower limb joints, are less documented. Here, we documented the biomechanical fingerprint of end-stage hip and knee osteoarthritis patients in terms of ipsilateral and contralateral hip and knee loading during walking and stair ambulation.
Three-dimensional motion-analysis was performed in 20 hip, 18 knee osteoarthritis patients and 12 controls during level walking and stair ambulation. Joint contact forces were calculated using a standard musculoskeletal modelling workflow in Opensim. Involved and contralateral hip and knee joint loading was compared against healthy controls using independent t-tests (p < 0.05).
Both hip and knee cohorts significantly decreased loading of the involved joint during gait and stair ambulation. Hip osteoarthritis patients presented no signs of ipsilateral knee nor contralateral leg overloading, during walking and stair ascending. However, knee osteoarthritis patients significantly increased loading at the ipsilateral hip, and contralateral hip and knee joints during stair ambulation compared to controls.
The biomechanical fingerprint in knee and hip osteoarthritis patients confirmed antalgic movement strategies to unload the involved leg during gait. Only during stair ambulation in knee osteoarthritis patients, movement adaptations were confirmed that induced unbalanced intra- and inter-limb loading conditions, which are known risk factors for secondary osteoarthritis.
骨关节炎是一种影响髋关节和膝关节的高发性疾病，其特征为负荷介导的疼痛和生活质量下降。根据受累关节的不同，患者会出现止痛性运动代偿，旨在减轻受累关节的负荷。然而，同侧和对侧下肢关节机械负荷的相关变化记录较少。在此，我们记录了终末期髋和膝骨关节炎患者在行走和上下楼梯过程中同侧和对侧髋和膝关节负荷方面的生物力学特征。
对20例髋骨关节炎患者、18例膝骨关节炎患者和12例对照者在平路行走和上下楼梯过程中进行三维运动分析。使用Opensim中的标准肌肉骨骼建模工作流程计算关节接触力。使用独立t检验（p < 0.05）将受累及对侧髋和膝关节负荷与健康对照者进行比较。
髋和膝骨关节炎患者队列在步态和上下楼梯过程中均显著降低了受累关节的负荷。髋骨关节炎患者在行走和上楼梯过程中未表现出同侧膝关节或对侧腿部过载的迹象。然而，与对照组相比，膝骨关节炎患者在上下楼梯过程中同侧髋、对侧髋和膝关节的负荷显著增加。
髋和膝骨关节炎患者的生物力学特征证实了止痛性运动策略，即在步态中减轻受累腿部的负荷。仅在膝骨关节炎患者上下楼梯过程中，证实了运动适应性会导致肢体内部和肢体间负荷失衡，而这是继发性骨关节炎的已知危险因素。
