How peak knee loads are affected by changing the mass of lower-limb body segments during walking

For individuals with knee osteoarthritis, increased knee loading is linked to disease progression and pain. Some approaches to treating osteoarthritis, such as specialized footwear, braces, and powered exoskeletons, also increase the mass of the lower limbs, which could lead to increases in knee loads. Prior studies have investigated the effect of changes in torso mass and total body mass on peak knee contact forces, but the effects of increased leg mass remain unclear. In this study, we created musculoskeletal simulations informed by experimental data to estimate tibiofemoral knee contact force under different lower-limb segment mass conditions. The mass of the foot, shank, and thigh were varied by adding weights to each segment, separately and concurrently, as healthy young adults (N = 10) walked on a treadmill. Kinematics, kinetics, and muscle activity were recorded. Our simulations used an optimal control framework that enforced experimental kinematics while minimizing a combination of net joint moment errors and mismatch between measured and estimated muscle activity. The simulations revealed that adding mass to the lower-limb segments linearly increased early- and late-stance peaks in knee contact force, but that the slope of this relationship was different for each peak and each mass placement location. For each 1% of body weight (BW) added per limb (2% BW total) at the thigh, shank, and foot, early-stance peak knee contact force increased by 1.5%, 2.1%, and 5.9% (r = 0.71), while late-stance peak contact force increased by 1.6%, 0.9% and 3.0% (r = 0.67), respectively. Adding mass to the thigh and shank increases peak contact force at or below the rate of increase in body mass, while adding mass to the foot disproportionately increases peak knee contact force. These detrimental effects should be considered when designing interventions for osteoarthritis.