Patients with knee osteoarthritis can be divided into subgroups based on tibiofemoral joint kinematics of gait – an exploratory and dynamic radiostereometric study,Osteoarthritis and Cartilage

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Patients with knee osteoarthritis can be divided into subgroups based on tibiofemoral joint kinematics of gait – an exploratory and dynamic radiostereometric study
Osteoarthritis and Cartilage ( IF 7.2 ) Pub Date : 2021-10-29 , DOI: 10.1016/j.joca.2021.10.011
E T Petersen ₁ , S Rytter ₂ , D Koppens ₃ , J Dalsgaard ₄ , T B Hansen ₅ , N E Larsen ₆ , M S Andersen ₇ , M Stilling ₈

Affiliation

University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Lægårdvej 12 Holstebro, 7500, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99 Aarhus N, 8200, Denmark; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 Aarhus N, 8200, Denmark.
Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 Aarhus N, 8200, Denmark.
University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Lægårdvej 12 Holstebro, 7500, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 Aarhus N, 8200, Denmark.
University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Lægårdvej 12 Holstebro, 7500, Denmark.
University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Lægårdvej 12 Holstebro, 7500, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99 Aarhus N, 8200, Denmark.
Department of Radiology, Holstebro Central Hospital, Lægårdvej 12 Holstebro, 7500, Denmark; Department of Radiology, Aarhus University, Palle Juul-Jensens Boulevard 99 Aarhus N, 8200, Denmark.
Department of Materials and Production, Aalborg University, Fibigerstræde 16 Aalborg, 9220, Denmark.
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99 Aarhus N, 8200, Denmark; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 Aarhus N, 8200, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165 Aarhus N, 8200, Denmark.

Objective

Patients with advanced knee osteoarthritis (KOA) frequently alter their gait patterns in an attempt to alleviate symptoms. Understanding the underlying pathomechanics and identifying KOA phenotypes are essential to improve treatments. We investigated kinematics in patients with KOA to identify subgroups of homogeneous knee joint kinematics.

Method

A total of 66 patients with symptomatic KOA scheduled for total knee arthroplasty and 15 age-matched healthy volunteers with asymptomatic, non-arthritic knees were included. We used k-means clustering to divide patients into subgroups based on dynamic radiostereometry-assessed tibiofemoral joint kinematics. Clinical characteristics such as knee ligament lesions and KOA scores were graded by magnetic resonance imaging and radiographs, respectively.

Results

We identified four clusters that were supported by clinical characteristics. The flexion group (n = 20) consisted primarily of patients with medial KOA. The abduction group (n = 17) consisted primarily of patients with lateral KOA. The anterior draw group (n = 10) was composed of patients with medial KOA, some degree of anterior cruciate ligament lesion and the highest KOA score. The external rotation group (n = 19) primarily included patients with medial collateral and posterior cruciate ligament lesions.

Conclusion

Based on tibiofemoral gait patterns, patients with advanced KOA can be divided into four subgroups with specific clinical characteristics and different KOA-affected compartments. The findings add to our understanding of how knee kinematics may affect the patient's development of different types of KOA. This may inspire improved and more patient-specific treatment strategies in the future.

中文翻译：

膝关节骨性关节炎患者可根据步态的胫股关节运动学分为亚组——一项探索性和动态放射立体测量研究

客观的

患有晚期膝骨关节炎 (KOA) 的患者经常改变他们的步态模式以试图缓解症状。了解潜在的病理机制和识别 KOA 表型对于改善治疗至关重要。我们研究了 KOA 患者的运动学，以确定均质膝关节运动学的亚组。

方法

共有 66 名有症状的 KOA 患者计划进行全膝关节置换术和 15 名年龄匹配的无症状、非关节炎膝关节的健康志愿者。我们使用 k-means 聚类根据动态放射立体测量评估的胫股关节运动学将患者分成亚组。膝关节韧带损伤和KOA评分等临床特征分别通过磁共振成像和X线片进行分级。

结果

我们确定了四个受临床特征支持的集群。屈曲组( n = 20) 主要由内侧 KOA 患者组成。外展组( n = 17) 主要由外侧 KOA 患者组成。前抽组（n = 10）由内侧 KOA、一定程度的前交叉韧带损伤和最高 KOA 评分的患者组成。外旋组（n = 19）主要包括内侧副和后交叉韧带损伤的患者。