Estrategias potencias para reducir el compartimento de carga central en pacientes con osteoartritis de rodilla de sensibilidad variable. Reducción de la velocidad andando.
Anne Mündermann 1 *, Chris O. Dyrby 1, Debra E. Hurwitz 2, Leena Sharma 3, Thomas P. Andriacchi 4 1Stanford University, Stanford, California 2Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 3Feinberg School of Medicine, Northwestern University, Chicago, Illinois 4Stanford University and Stanford University Medical Center, Stanford, California, and Bone and Joint Center, Palo Alto Veterans Administration, Palo Alto, California
To determine whether reducing walking speed is a strategy used by patients with knee osteoarthritis (OA) of varying disease severity to reduce the maximum knee adduction moment. Methods
Self-selected walking speeds and maximum knee adduction moments of 44 patients with medial tibiofemoral OA of varying disease severity, as assessed by using the Kellgren/Lawrence grade, were compared with those of 44 asymptomatic control subjects matched for sex, age, height, and weight. Results
Differences in self-selected normal walking speed explained only 8.9% of the variation in maximum knee adduction moment for the group of patients with knee OA. The severity of the disease influenced the adduction moment-walking speed relationship; the individual slopes of this relationship were significantly greater in patients with less severe OA than in asymptomatic matched control subjects. Self-selected walking speed did not differ between patients with knee OA, regardless of the severity, and asymptomatic control subjects. However, knees with more-severe OA had significantly greater adduction moments (mean ± SD 3.80 ± 0.89% body weight × height) and were in more varus alignment (6.0 ± 4.5°) than knees with less-severe OA (2.94 ± 0.70% body weight × height; and 0.0 ± 2.9°, respectively). Conclusion
Patients with less-severe OA adapt a walking style that differs from that of patients with more-severe OA and controls. This walking style is associated with the potential to reduce the adduction moment when walking at slower speeds and could be linked to decreased disease severity.