The Effect of Torsion Deformity and Medial Knee Osteoarthritis on Lower Limb Extensor Moments during Gait

DOI: 10.4236/ojra.2013.32018   PDF   HTML     3,869 Downloads   6,272 Views   Citations

Abstract

The aim of this study was to quantify the effect of torsion deformity on the lower limb kinetics during the loading response phase of gait. A total of 24 subjects: 6 end-staged medial knee OA with torsion deformity (TKO), 8 without torsion deformity (KOA), and 10 controls (CON) were imaged using computed tomography (CT). Internal moment of support and sagittal hip, knee and ankle joint moments were assessed using gait analysis. TKO showed greater external rotations of the proximal tibia and the distal femur compared to subjects with medial knee OA without torsion deformity and controls. TKO showed greater moment of support and a greater knee extensor moment when compared to controls when supporting the weight of the body during gait. The TKO intorsion deformity occurred as a result of a proximal malrotation of the tibia. In the presence of torsion deformity, the kinetic synergy of the lower limb showed increased total moment of support for subjects with medial knee OA. The greater extensor output from TKO may be the result of an increased muscular response to overcome an interrupted inter-segmental exchange of accelerations during the loading response phase of gait.

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D. Mandeville, K. Krackow, S. Rachala and M. Bayers-Thering, "The Effect of Torsion Deformity and Medial Knee Osteoarthritis on Lower Limb Extensor Moments during Gait," Open Journal of Rheumatology and Autoimmune Diseases, Vol. 3 No. 2, 2013, pp. 119-124. doi: 10.4236/ojra.2013.32018.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] K. Krackow, C. L. Pepe and E. J. Galloway, “A Mathematical Analysis of the Effect of Flexion and Rotation on Apparent Varus/Valgus Alignment at the Knee,” Orthopedics, Vol. 13, No. 8, 1990, pp. 861-868.
[2] K. Krackow, “The Technique of Total Knee Arthroplasty,” C.V. Mosby Company, Baltimore, 1990.
[3] K. Krackow, C. D. Miller, W. M. Mihalko, L. J. Serpe, M. B. Thering and M. J. Philips, “Thinking about Deformity and Alignment in TKA,” Orthopedics, Vol. 20, No. 9, 1997, pp. 825-826.
[4] K. Krackow, D. S. Mandeville, S. R. Rachala, M. Bayers-Thering and L. R. Osternig, “Torsion Deformity and Joint Loading for Medial Knee Osteoarthritis,” Gait & Posture, Vol. 33, No. 4, 2011, pp. 625-629. doi:10.1016/j.gaitpost.2011.02.006
[5] J. Weidow, I. Mars and J. Karrholm, “Medial and Lateral Osteoarthritis of the Knee Is Related to Variations of Hip and Pelvic Anatomy,” Osteoarthritis and Cartilage, Vol. 13, No. 6, 2005, pp. 471-477. doi:10.1016/j.joca.2005.01.009
[6] J. Hicks, A. Arnold, F. Anderson, M. Schwartz and S. Delp, “The Effect of Excessive Tibial Torsion on the Capacity of Muscles to Extend the Hip and Knee during Single-Limb Stance,” Gait & Posture, Vol. 26, No. 4, 2007, pp. 546-552. doi:10.1016/j.gaitpost.2006.12.003
[7] D. Mandeville, L. R. Osternig and L. S. Chou, “The Effect of Total Knee Replacement on Dynamic Support of the Body during Walking and Stair Ascent,” Clinical Biomechanics, Vol. 22, No. 7, 2007, pp. 787-794. doi:10.1016/j.clinbiomech.2007.04.002
[8] D. Winter, “Overall Principle of Lower Limb Support during Stance Phase of Gait,” Journal of Biomechanics, Vol. 13, No. 11, 1980, pp. 923-927. doi:10.1016/0021-9290(80)90162-1
[9] F. Anderson and M. G. Pandy, “Individual Muscle Contributions to Support in Normal Walking,” Gait & Posture, Vol. 17, No. 12, 2003, pp. 159-169. doi:10.1016/S0966-6362(02)00073-5
[10] R. Dunteman, S. J. Vankoski and L. S. Dias, “Internal Derotation Osteotomy of the Tibia: Pre and Postoperative Gait Analysis in Persons with High Sacral Myelomeningocele,” Journal of Pediatric Orthopaedics, Vol. 20, No. 5, 2000, pp. 623-628. doi:10.1097/01241398-200009000-00014
[11] R. Stefko, R. J. de Swart, D. A. Dodgin, M. P. Wyastt, K. R. Kaufman, D. H. Sutherland and H. G. Chambers, “Kinematic and Kinetic Analysis of Distal Derotational Osteotomy of the Leg in Children with Cerebral Palsy,” Journal of Pediatric Orthopaedics, Vol. 18, No. 1, 1998, pp. 81-87. doi:10.1097/01241398-199801000-00016
[12] A. Arnold, S. S. Blemker and S. L. Delp, “Evaluation of a Deformable Musculoskeletal Model for Estimating Muscle-Tendon Lengths during Crouch Gait,” Annals of Biomedical Engineering, Vol. 29, No. 3, 2001, pp. 263-274. doi:10.1114/1.1355277
[13] S. Ounpuu, P. DeLuca, R. Davis and M. Romness, “Long-Term Effects of Femoral Derotation Osteotomies: An Evaluation Using Three-Dimensional Gait Analysis,” Journal of Pediatric Orthopaedics, Vol. 22, No. 2, 2002, pp. 139-145. doi:10.1097/01241398-200203000-00001
[14] M. Turner, “The Association between Tibial Torsion and Knee Joint Pathology,” Clinical Orthopaedics and Related Research, Vol. 302, 1994, pp. 47-51.
[15] J. Weidow, R. Tranberg, T. Saari and J. Karrholm, “Hip and Knee Joint Rotations Differ between Patients with Medial and Lateral Knee Osteoarthritis: Gait Analysis of 30 Patients and 15 Controls,” Journal of Orthopaedic Research, Vol. 24, No. 9, 2006, pp. 1890-1899. doi:10.1002/jor.20194
[16] C. Radler, A. Kranzl, H. M. Manner and M. Hoglinger, “Torsional Profile versus Gait Analysis: Consistency between the Anatomic Torsion and the Resulting Gait Pattern in Patients with Rotational Malalignment of the Lower Extremity,” Gait & Posture, Vol. 32, No. 3, 2010, pp. 405-410. doi:10.1016/j.gaitpost.2010.06.019
[17] D. Mandeville, L. R. Osternig and L. S. Chou, “The Associations between Knee Flexion, Vertical Center-of-Mass Excursions and Lower-Extremity Muscle Work for End-Stage Knee Osteoarthritis,” Journal of Musculoskeletal Research, Vol. 12, No. 2, 2009, p. 7. doi:10.1142/S0218957709002213
[18] C. McGibbons and D. E. Krebs, “Compensatory Gait Mechanics in Patients with Unilateral Knee Arthritis,” Journal of Rheumatology, Vol. 29, No. 11, 2002, pp. 2410-2419.
[19] D. Hudson, T. Royer and J. Richards, “Ultrasound Measurements of Torsions in the Tibia and Femur,” The Journal of Bone & Joint Surgery, Vol. 88, No. 1, 2006. pp. 138-143. doi:10.2106/JBJS.D.02924
[20] D. Eckhoff, “Effect of Limb Malrotation on Malalignment and Osteoarthritis,” Orthopedic Clinics of North America, Vol. 25, No. 3, 1994, pp. 405-414.
[21] M. Kadaba, H. K. Ramakrishnan and M. E. Wooten, “Measurement of Lower Extremity Kinematics during Level Walking,” Journal of Orthopaedic Research, Vol. 8, No. 3, 1990, pp. 383-392. doi:10.1002/jor.1100080310

  
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