Biomechanics of knee osteoarthritis during stair negotiation: mechanisms and intervention strategies

Doslikova, Katerina (2015) Biomechanics of knee osteoarthritis during stair negotiation: mechanisms and intervention strategies. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

In this thesis I evaluated a mixed knee OA group with medial tibiofemoral (TF) and patellofemoral (PF) OA and healthy age- and BMI-matched controls during stair negotiation. Participants were examined walking on a seven-step staircase with four embedded force platforms and kinematic data were recorded using a ten-camera motion capture system. Biomechanics of lower limb joints and balance control during this task was compared between groups. Secondly, strategies aimed at reducing the pain and task difficulty were evaluated, namely the use of a PF knee brace and use of the stair handrail. Results showed that the OA group negotiated stairs with a reduced knee joint moment in the sagittal plane, but a greater knee joint moment in the frontal plane compared to controls. No major balance differences were identified between the groups, with the exception of a greater centre of mass velocity in the OA group in the final phase of lowering during stair descent. A PF brace reduced the knee joint moment in the sagittal plane during stair ascent in OA patients, which would be expected to reduce PF loading. In OA patients, stair handrail use on the contralateral side to the affected knee reduced frontal plane knee joint moments, with implications for TF loading and handrail use regardless of side reduced sagittal plane knee joint moments, with implications for PF loading. This thesis adds to the current knowledge about knee OA and stair negotiation. This body of work has identified biomechanical alterations at the knee joint in a mixed knee OA population, which do not impact markedly upon balance control during stair negotiation. Intervention strategies involving PF bracing and use of stair handrails offer simple, but effective strategies for altering biomechanical demands on the knee and mitigating disease progression.