Joint loading and proximal tibia subchondral trabecular bone microarchitecture differ with walking gait patterns in...

Area of Science:

• Orthopedics
• Biomechanics
• Biomaterials Science

Background:

• End-stage knee osteoarthritis (OA) significantly impacts joint loading and bone microarchitecture.
• Understanding gait patterns is crucial for stratifying patients and tailoring treatments.
• Subchondral trabecular bone (STB) alterations are key indicators of OA progression.

Purpose of the Study:

• To stratify knee OA patient subgroups based on distinct walking gait patterns.
• To compare joint loading and proximal tibia STB microarchitecture across identified gait subgroups.
• To investigate the relationship between gait, joint loading, and bone health in knee OA.

Main Methods:

• Pre-operative gait analysis was performed on 25 knee OA patients undergoing total knee arthroplasty (TKA).
• Excised tibial plateaus were micro-CT-scanned to analyze STB microarchitecture.
• K-means cluster analysis identified gait subgroups based on peak knee moments, followed by comparative statistical analysis.

Main Results:

• Three distinct gait subgroups were identified: biphasics (n=7), flexors (n=9), and counter-rotators (n=9).
• Biphasic gait exhibited significantly higher peak knee adduction moment (KAM) and KAM impulse compared to flexors and counter-rotators.
• STB medial-to-lateral bone volume fraction (BV/TV) ratio was significantly higher in biphasics and flexors than in counter-rotators.

Conclusions:

• Different gait mechanisms may result in comparable joint loading and bone responses in knee OA patients.
• Conservative treatments targeting KAM reduction may not be suitable for all knee OA gait patterns, particularly flexor gait.
• Understanding gait-bone microarchitecture relationships can improve management strategies for individuals at risk of knee OA.