Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (47)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Wada, M.
Right arrow Articles by Nose, Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wada, M.
Right arrow Articles by Nose, Y.
Related Collections
Right arrow Osteoarthritis and Cartilage
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Rheumatology 2001; 40: 499-505
© 2001 British Society for Rheumatology

Original Papers

Relationships among bone mineral densities, static alignment and dynamic load in patients with medial compartment knee osteoarthritis

M. Wada, Y. Maezawa1, H. Baba1, S. Shimada, S. Sasaki and Y. Nose

Division of Rehabilitation Medicine, Fukui Medical University, Fukui and
1 Department of Orthopaedic Surgery, Fukui Medical University, Fukui, Japan


   Abstract
Top
 Abstract
Introduction
 Subjects and methods
 Results
 Discussion
 References
 
Objective. To investigate the relationships among bone mineral density (BMD), static alignment and the adduction moment of the knee in patients with tibiofemoral osteoarthritis (OA).

Methods. Sixty-nine patients with medial compartment knee OA underwent radiographic evaluation, gait analysis and BMD measurements at the proximal tibia and lumbar spine.

Results. The bone mineral distribution of the medial to lateral part of the proximal tibia correlated significantly with the peak knee adduction moment and the mechanical axis. Furthermore, the adduction moment correlated significantly with the mechanical axis. However, the BMD of the lumbar spine and the bone mineral distribution of the posterior to anterior part of the proximal tibia did not correlate with any other measurement.

Conclusions. Our results suggest that the bone mineral distribution of the proximal tibia is directly affected but lumbar BMD is not influenced by the local mechanical stress around the knee with medial compartment OA.

KEY WORDS: Bone mineral density, Alignment, Knee osteoarthritis, Mechanical load.


   Introduction
Top
 Abstract
 Introduction
Subjects and methods
 Results
 Discussion
 References
 
The negative relationship between general osteoporosis and osteoarthritis (OA) is well described. Patients with knee or hip OA show higher bone mineral density (BMD) compared with normal subjects [1–9]. In particular, women with osteophytes have significantly higher femoral BMD than women without osteophytes [2]. Belmonte-Serrano et al. [9] demonstrated that BMD of the total body and lumbar spine measured by dual-photon absorptiometry correlated positively with radiographic knee OA scores; these results did not seem to be due to the local effects of OA on specific areas but probably represented the general relationship between the disease and bone metabolism. Few investigators have attributed the high BMD in patients with knee OA mainly to increased bone turnover [2, 8], while other studies have indicated less bone turnover in premenopausal patients with knee OA [7]. Tibiofemoral knee OA usually shows varus or valgus alignment as well as eccentric high stress distribution in the affected compartment. However, very little is known about the influence of the static alignment or dynamic load of the OA knee joint on the BMD of the lumbar spine [10].

One of the mechanisms of initiation and progression of articular cartilage damage is increased density or stiffness of the underlying subchondral bone [11–14]. Previous in vitro studies have shown that the mechanical properties of the trabecular bone correlate with the load distribution at the proximal tibia [15–19]. Site-specific bone mineral contents of the proximal tibia have been measured by dual-photon absorptiometry and quantitative computed tomography [20–24]. Recently, BMD measurements in this area have been reported using dual-energy X-ray absorptiometry (DXA) in patients with knee OA [25–27]. Previous studies showed that the BMD of the medial tibial plateau was higher than that of the lateral tibial plateau and the bone mineral distribution was associated with the alignment of the lower extremity, suggesting that the load-bearing trabecular bone site has a higher bone mineral density than the unloaded site [20, 23, 24, 27]. Recently, Hurwitz et al. [28] demonstrated a significant relationship between proximal tibial BMD and the magnitude of the dynamic load in normal subjects. However, to our knowledge, the relationships among dynamic load, bone mineral distribution and static alignment of the lower extremity and whether such relationships hold in patients with tibiofemoral OA have not been determined. Among the components of the dynamic load on the knee during walking, the adduction moment of the knee is considered to be the most influential factor contributing to the medial joint force in joints with varus deformity [29, 30]. The purpose of this study was to determine the relationships among BMD of the lumbar spine and proximal tibia, static alignment and OA disease severity, and the adduction moment of the knee in patients with OA of the medial compartment of the knee.


   Subjects and methods
Top
 Abstract
 Introduction
 Subjects and methods
Results
 Discussion
 References
 
Patients
Sixty-nine patients with bilateral medial compartment knee joint OA with radiographically similar disease severity, managed at Fukui Medical University Hospital, were enrolled in this study. All patients had a definitive diagnosis of OA according to the American College of Rheumatology criteria [31]. Patients were excluded from the study if they had symptomatic musculoskeletal disorders other than those affecting the knee joints, a history of major trauma or sports injury of the knee, rheumatoid arthritis, gout, pseudogout, autoimmune diseases, neuropathic arthropathy, infectious disease or another major systemic disease. The characteristics of the patients are shown in Table 1Go. Although all subjects had bilateral knee disease, measurements were performed on the more symptomatic knee in each patient. Each subject underwent measurements of BMD, radiographic evaluation and gait analysis after a 4-week washout period of anti-inflammatory medications and physiotherapy. The study was approved by the ethics committee of our institution and written informed consent was obtained from all patients.


View this table:
[in this window]
[in a new window]
  		TABLE 1. Characteristics of patients with OA of the knee

 

Measurement of BMD
Proximal tibiae were scanned by DXA (QDR-1000; Hologic, Walham, MA, USA). Anteroposterior (AP) measurement was performed while the subject was in the supine position on the DXA table with the patella fixed in the upright position. The lower leg was fixed on the mattress with the knee flexed 20° so that the tibia was aligned parallel to the table. For the lateral scan, the lateral side of the knee was in contact with the table. The prosthetic hip subregion mode was used to scan the knee in both directions. Regions of interest (ROI) were placed on the AP image over the medial and lateral regions beneath the subchondral plates of the proximal tibia. ROI were also set on the lateral image over the anterior and posterior regions of the same level of the tibia (Fig. 1Go). To evaluate bones with the same quality between different sites, only regions including trabecular bone in each image were selected for ROI. The BMD of the lumbar spine (L1–4) was measured in the AP view using the conventional protocol provided by the manufacturer. To determine precision error, eight OA knees were scanned three times on different days (within 28 days) with repositioning between scans. The coefficients of variation of BMD in the medial, lateral, anterior and posterior parts of the proximal tibia and in the lumbar spine were 4, 2, 3, 3 and 2% respectively.



View larger version (132K):
[in this window]
[in a new window]
  		FIG. 1. Bone mineral density of the proximal part of the tibia obtained from AP and lateral scan images. The four regions of interest were selected at the medial (M), lateral (L), anterior (A) and posterior (P) parts of the proximal tibia.

 

Gait analysis
The computed gait analysis system (Anima, Tokyo, Japan) used in this study included two force plates (each 250x40 cm) and a light source spot-measuring device (consisting of light-emitting diodes attached to the body and four optoelectronic cameras that captured the emitted light). The two force plates were placed on the floor on either side of the centre line of an 8-m walkway.

The reflective skin markers for the light source measuring device were attached to both acromions, the anterior superior iliac spine, the iliac crest, the greater trochanter, the lateral joint line of the knee, the lateral malleolus of the fibula, the lateral side of the calcaneus and the head of the fifth metatarsal bone. Signals of three-dimensional reaction forces detected by the force plates were passed through an analogue–digital converter to a computer. Joint angles were calculated from the relative translations and rotations of the segments, which were detected directly as the three-dimensional positions of the skin markers by the optoelectronic cameras. The captured marker coordinates were filtered with a low-pass digital filter at a cut-off frequency of 6 Hz. The resolution of the cameras in the detection of three-dimensional locations of the floor reaction forces was <0.5%; the measurement error of the floor reaction forces obtained from the force plate was also <0.5%.

After several walking trials, the patient was asked to ambulate on the force plate at his or her natural walking speed three times, with both arms folded in front of the chest so as not to interfere with the light from the light source. The sampling frequency was set at 50 Hz (20 ms). As the average walking speed of the subjects was 0.6 m/s, the gait data for the individual patients with walking speed nearest to 0.6 m/s were selected. The positions of the centres of the hip, knee and ankle joints were identified relative to the positions of the skin markers. The centre of the hip joint was approximated at the point that was located some distance inward from the greater trochanter. The distance was measured on the AP radiographs of each hip joint. The centre of the knee on the frontal plane was located by identifying the mid-point of the line between the peripheral margins of the medial and lateral plateaux at the level of the joint line. The centre of the ankle joint was estimated at the mid-point between lateral and medial malleoli [28, 32, 33]. Data on distances from the skin marker to the centre were entered into the computer. Moments of the knee joint were computed by the use of the three-dimensional rigid body link model of Bresler and Frankel [34], incorporating the data on the three-dimensional location of each segment, the inertial properties of the limb segment and the data on the floor reaction forces [35].

Radiographic evaluation
All patients had standing AP radiographs of the knee and full-length AP radiographs of the whole lower extremity in full extension of the knee. The projection angle of the radiograph was determined from the lateral radiograph by measuring the posterior tilt of the medial tibial plateau. The AP radiograph of the knee was then obtained with the radiographic beam directed parallel to the medial tibial plateau. From the AP radiograph of the knee, the severity of medial compartment knee OA was classified according to the Kellgren–Lawrence grading system [36]. The narrowest width of the joint space was measured in millimetres in the medial compartment. From the full-length weight-bearing AP radiographs of the lower extremity, the static alignment of the lower extremity was expressed using the mechanical axis, which represented the angle between the line connecting the centre of the femoral head and the centre of the tibial plateau and the line connecting the centre of the tibial plateau and the centre of the ankle joint. In addition, the degree of varus deformity of the proximal tibia was expressed as the tibial condylar angle, representing the angle between the line parallel to the tibial plateau and the line connecting the centre of the tibial plateau and the centre of the ankle joint (Fig. 2Go).



View larger version (12K):
[in this window]
[in a new window]
  		FIG. 2. Illustration to show (A) the mechanical axis and (B) the tibial condylar angle from the full-length weight-bearing AP radiograph of the lower extremity.

 

Statistical analysis
Quantitative group data were expressed as median and range. The Mann–Whitney U-test was used to compare differences in disease severity and gender. The Wilcoxon signed rank test was used to compare BMD between the medial and lateral or anterior and posterior parts of the proximal tibia. Correlations among variables were assessed with Spearman's rank correlation test. Multiple regression analysis was used to test for associations among variables after adjusting for age, sex and/or body height and weight. A two-tailed P value less than 0.05 was considered statistically significant.


   Results
Top
 Abstract
 Introduction
 Subjects and methods
 Results
Discussion
 References
 
The results of BMD measurements are shown in Table 2Go. The tibial BMD of the medial compartment was significantly higher than that of the lateral compartment in both mild and severe OA (P<0.05 and P<0.001 respectively). Likewise, the BMD of the posterior tibial region was significantly higher than that of the anterior tibial region in both mild and severe OA (P<0.05 for mild OA and P<0.001 for severe OA). The BMDs of the tibial regions correlated significantly with each other (r=0.43–0.77, P<0.01). The ratio of the BMD of the medial tibial plateau relative to the lateral tibial plateau (M/L ratio) was higher in severe OA than in mild OA (P<0.01), while the ratio of the BMD of the posterior tibial plateau relative to the anterior tibial plateau (P/A ratio) was not different between mild and severe OA. The BMD of the lumbar spine was also not different between groups. The peak adduction moment for severe OA was 30% higher than that for mild OA (P=0.06). In severe OA, the mechanical axis was significantly larger (P<0.001), the minimum joint space width was smaller (P<0.001) and the tibial condylar angle was smaller (P<0.05) than in mild OA (Table 1Go).


View this table:
[in this window]
[in a new window]
  		TABLE 2. BMD (g/cm2), static alignment and adduction moment of the knee in patients with mild (Kellgren–Lawrence grades 1 and 2) and severe (grades 3 and 4) knee OA

 
The BMD of each measured site in the proximal tibia was not significantly different between men and women except for the M/L ratio. In women, the M/L ratio was significantly higher (P<0.05), the BMD of the lumbar spine was significantly lower (P<0.01) and the mechanical axis was significantly larger (P<0.05) than in men. The peak adduction moment, the minimum joint space width and the tibial condylar angle were not significantly different between men and women (Table 3Go).


View this table:
[in this window]
[in a new window]
  		TABLE 3. BMD (g/cm2), static alignment and adduction moment of the knee in male and female patients with knee OA

 
There were significant correlations between the M/L ratio and the mechanical axis (r=0.53, P<0.001; Fig. 3AGo), the peak adduction moment of the knee (r=0.52, P<0.001, Fig. 3BGo), the minimal joint space width of the medial compartment (r=0.46, P<0.05), the tibial condylar angle (r=-0.41, P<0.01) and the grade of OA severity (r=0.48, P<0.01). Significant correlations were still present after adjusting for age, sex, height and body weight.



View larger version (20K):
[in this window]
[in a new window]
  		FIG. 3. (A and B) Relationship between mechanical axis and medial to lateral bone mineral distribution of the proximal tibia (A) and peak adduction moment of the knee (B). (C) Relationship between peak adduction moment of the knee and medial to lateral bone mineral distribution of the proximal tibia. All correlations are statistically significant. BW, body weight, HT, height.

 
The adduction moment of the knee correlated significantly with the mechanical axis (r=0.62, P<0.001; Fig. 3CGo) and tibial condylar angle (r=-0.50, P<0.01) in addition to the M/L ratio. Significant correlations were still present after adjusting for age and sex.

The BMD of the lumbar spine correlated significantly with the BMD of the anterior (r=0.41, P<0.01), posterior (r=0.52, P<0.001) and lateral (r=0.34, P<0.05) parts of the proximal tibia, and significant correlations were still present after adjusting for age, sex, height and body weight. The P/A ratio did not correlate with any other measurement.


   Discussion
Top
 Abstract
 Introduction
 Subjects and methods
 Results
 Discussion
References
 
In this study, the BMD of the proximal tibia was higher in the medial compartment than in the lateral compartment and higher in the posterior region than the anterior region in OA of the medial compartment of the knee. This finding is probably due to increased weight bearing on the medial condyle relative to the lateral condyle with varus deformity [20, 24, 27] and seems to be associated with the fact that the articular cartilage of medial compartment knee OA is predominantly affected in the posterior part of the articular cartilage or flexion contracture that is usually seen in advanced knee OA. In addition, we found that the M/L ratio of the proximal tibial BMD increased with increasing adduction moment, more varus alignment and more advanced medial compartment OA grade. However, the bone mineral distribution of the proximal tibia in the sagittal plane (the P/A ratio) did not correlate with any other measurement. Therefore, the bone mineral distribution of the proximal tibia in medial compartment knee OA was associated mainly with the articular load distribution in the frontal plane, and the load distribution in the sagittal plane varied widely with the severity of OA.

On the basis of our cross-sectional study, we do not think one can conclude that the higher BMD was a consequence of a higher load. However, other groups have shown changes in subchondral bone density of the proximal tibia in knee OA [12, 27]. Previous studies have shown the presence of thick trabecular bone in areas with high BMD that could have formed by higher mechanical load [13, 20]. Thus, it is likely that higher BMD was a consequence of higher load in this study. In addition, others have postulated that repetitive cumulative microdamage leads to the remodelling and stiffening of bone [11]. Therefore, both thicker trabecular bone and microfracture of the cancellous bone may be caused by the high BMD, and the presence of stiff subchondral bone may result in further damage to the articular cartilage in our patients with established OA. If these relationships are applied clinically, our results suggest that the evaluation of BMD at the proximal tibia, the adduction moment of the knee or the static alignment may help in predicting disease progression in patients with medial compartment knee OA. In addition, it has been reported that, in normal adults, bone mineral distribution in the proximal tibia is associated with the peak adduction moment of the knee [28]. Therefore, evaluation of the BMD at the proximal tibia and the adduction moment in healthy adults may help in predicting those at risk of knee OA.

In this study, we have shown a significant relationship between the adduction moment and the static alignment of the lower extremity or varus deformity of the upper tibia. However, there is controversy regarding the relationship between the peak knee adduction moment and the static alignment of the lower extremity [37–43]. Even in studies that supported positive relationships [38, 39, 43], the associations were relatively weak. It is suggested, therefore, that the adduction moment of the knee and static alignment do not correlate when the individual patient adopts a compensatory mechanism to unload the knee [44].

It has been reported that the BMD of the lumbar spine correlates with disease severity [5] or varus deformity at the proximal tibia [10] in knee OA. However, we did not find such a relationship in the present study. This discrepancy may be due to the different characteristics of the participating subjects or to sample size. In addition, our results showed the lack of relationship between the BMD of the lumbar spine and the adduction moment of the knee. These results suggest that lumbar BMD may not be affected directly by changes in local biomechanical characteristics or biological events such as osteopenia as a result of inflammatory cytokines [26] around the knee joint, although it is also possible that general or total body osteoporosis causes local osteopenia independently of the magnitude of local stress distribution.

In conclusion, we have demonstrated that the bone mineral distribution of the proximal tibia is affected directly but that the lumbar BMD is not influenced by local mechanical stress in patients with OA of the medial compartment of the knee.


   Notes
 
Correspondence to: M. Wada, Division of Rehabilitation Medicine, Fukui Medical University, Shimoaizuki 23, Matsuoka-cho, 910-1193, Fukui, Japan. Back


   References
Top
 Abstract
 Introduction
 Subjects and methods
 Results
 Discussion
 References
 

  1. Cooper C, Cook PL, Osmond C, Fisher L, Cawley MID. Osteoarthritis of the hip and osteoporosis of the proximal femur. Ann Rheum Dis1991;50:540–2.[Abstract/Free Full Text]
  2. Hannan MT, Anderson JJ, Zhang Y, Levy D, Felson DT. Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham study. Arthritis Rheum1993;12:1671–80.
  3. Hart DJ, Mootoosamy I, Doyle DV, Spector TD. The relationship between osteoarthritis and osteoporosis in the general population: The Chingford study. Ann Rheum Dis1994;53:158–62.[Abstract/Free Full Text]
  4. Yokozeki H, Igarashi M, Kurabe S, Shiraki M, Kurokawa T. The relation between osteoporosis of the spine and osteoarthritis of the knee. Int Orthop1995;19:282–4.[Medline]
  5. Burger H, van Daele PLA, Odding E et al. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam study. Arthritis Rheum1996;39:81–6.[Web of Science][Medline]
  6. Dequeker J. Inverse relationship of interface between osteoporosis and osteoarthritis. J Rheumatol1997;24:795–8.[Medline]
  7. Sowers M, Lachance L, Jamadar D et al. The association of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women. Arthritis Rheum1999;42:483–9.[Web of Science][Medline]
  8. Stewart A, Black A, Robins SP, Reid DM. Bone mineral density and bone turnover in patients with osteoarthritis and osteoporosis. J Rheumatol1999;26:622–6.[Medline]
  9. Belmonte-Serrano MA, Bloch DA, Lane NE, Michel BE, Fries JF. The relationship between spinal and peripheral osteoarthritis and bone density measurements. J Rheumatol1993;20:1005–13.[Medline]
  10. Terauchi M, Shirakura K, Katayama M, Higuchi H, Takagishi K. The influence of osteoporosis on varus osteoarthritis of the knee. J Bone Joint Surg Br1998;80B:432–6.
  11. Radin EL, Rose RM. Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop1986;213:34–9.
  12. Wu DD, Burr DB, Boyd RD, Radin EL. Bone and cartilage changes following experimental varus and valgus tibial angulation. J Orthop Res1990;8:572–85.[Web of Science][Medline]
  13. Zysset PK, Sonny M, Hayes WC. Morphology–mechanical property relations in trabecular bone of the osteoarthritic proximal tibia. J Arthroplasty1994;9:203–16.[Medline]
  14. Dequnker J, Mokassa L, Aerssens J, Boonen S. Bone density and local growth factors in generalized osteoarthritis. Microsc Res Tech1997;37:358–71.[Medline]
  15. Behrens JC, Walker PS, Shoji H. Variations in strength and structure of cancellous bone at the knee. J Biomech1994;7:201–7.
  16. Choi K, Goldstein SA. A comparison of the fatigue behaviour of human trabecular and cortical bone tissue. J Biomech1992;25:1371–81.[Web of Science][Medline]
  17. Noble J, Alexander K. Studies of tibial subchondral bone density and its significance. J Bone Joint Surg Am1985;67A:295–302.[Abstract/Free Full Text]
  18. Hvid I. Trabecular bone strength at the knee. Clin Orthop1988;227:210–21.[Medline]
  19. Harada Y, Wevers HW, Cooke TDV. Distribution of bone strength in the proximal tibia. J Arthroplasty1988; 3:167–75.[Medline]
  20. Christensen P, Kjaer J, Melsen F, Nielsen HE, Sneppen O, Vang PS. The subchondral bone of the proximal tibial epiphysis in osteoarthritis of the knee. Acta Orthop Scand1982;53:889–95.[Medline]
  21. Bohr HH, Schaadt O. Mineral content of upper tibia assessed by dual photon densitometry. Acta Orthop Scand1987;58:557–9.[Medline]
  22. Checovich MM, Kiratli BJ, Smith EL. Dual photon absorptiometry of the proximal tibia. Calcif Tissue Int1989;45:281–4.[Medline]
  23. Petersen MM, Olsen C, Lauritzen JB, Lund B. Bone mineral content assessed by dual photon absorptiometry in the proximal tibia: normative data and measurements in orthopedic conditions. Eur J Exp Musculoskel Res1993; 2:121–6.
  24. Madsen OR, Schaadt O, Briddal H, Egsmose C, Sylvest J. Bone mineral distribution of the proximal tibia in gonarthrosis assessed in vivo by photon absorption. Osteoarthritis Cartilage1994;2:141–7.[Medline]
  25. Sievaenen H, Oja P, Vuori I. Precision of dual-energy x-ray absorptiometry in determining bone mineral density and content of various skeletal sites. J Nucl Med1992; 33:1137–42.[Abstract/Free Full Text]
  26. Karvonen RL, Miller PR, Nelson DA, Granda JL, Fernandez-Madrid F. Periarticular osteoporosis in osteoarthritis of the knee. J Rheumatol1998;25:187–94.[Medline]
  27. Akamatsu Y, Koshino T, Saito T, Wada J. Changes in osteosclerosis of the osteoarthritic knee after high tibial osteotomy. Clin Orthop1997;334:207–14.
  28. Hurwitz DE, Sumner DR, Andriacchi TP, Sugar DA. Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech1998;31:423–30.[Web of Science][Medline]
  29. Schipplein OD, Andriacchi TP. Interaction between active and passive stabilizers during level walking. J Orthop Res1991;9:113–9.[Web of Science][Medline]
  30. Andriacchi TP. Dynamics of knee malalignment. Orthop Clin North Am1994;25:395–403.[Web of Science][Medline]
  31. Altman R, Asch E, Bloch D et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum1986;29:1039–49.[Web of Science][Medline]
  32. Andriacchi TP, Hampton SJ, Schultz AB, Galante JO. Three-dimensional coordinate data processing in human motion analysis. J Biomech Eng1979;101:279–83.[Web of Science]
  33. Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res1990;8:383–92.[Web of Science][Medline]
  34. Bresler B, Frankel JP. The forces and moments in the leg during level walking. Trans Am Soc Mech Eng1950;72:27–36.
  35. Wada M, Imura S, Nagatani K, Baba H, Shimada S, Sasaki S. Relationship between gait and clinical results after high tibial osteotomy. Clin Orthop1998;354:180–8.
  36. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthritis. Ann Rheum Dis1957;16:494–501.
  37. Wang H, Olney SJ. Relationship between alignment, kinematic and kinetic measures of the knee of normal elderly subjects in level walking. Clin Biomech1994; 9:245–52.
  38. Hilding MB, Lanshammar H, Ryd L. A relationship between dynamic and static assessments of knee joint load. Gait analysis and radiography before and after knee replacement in 45 patients. Acta Orthop Scand1995;66:317–20.[Web of Science][Medline]
  39. Weidenhielm L, Svensson OK, Brostrom LA, Mattsson E. Adduction moment of the knee compared to radiological and clinical parameters in moderate medial osteoarthrosis of the knee. Ann Chir Gynaecol1994;83:236–42.[Web of Science][Medline]
  40. Harrington IJ. Static and dynamic loading patterns in knee joints with deformities. J Bone Joint Surg Am1983; 65A:249–59.
  41. Johnson F, Leitl S, Waugh W. The distribution of load across the knee. A comparison of static and dynamic measurements. J Bone Joint Surg Br1980;62B:346–9.
  42. Prodromos CC, Andriacchi T, Galante JO. A relationship between gait and clinical changes following high tibial osteotomy. J Bone Joint Surg Am1985;67A:1188–93.[Abstract/Free Full Text]
  43. Kettelkamp DB, Wenger DR, Chao EYS, Thompson C. Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension and medial-plateau force. J Bone Joint Surg Am1976;58A:952–60.[Abstract/Free Full Text]
  44. Andrews M, Noyes FR, Hewett TE, Andriacchi TP. Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects. A critical analysis of the reliability of gait analysis data. J Orthop Res1996; 14:289–95.[Web of Science][Medline]
Submitted 7 February 2000; Accepted 27 November 2000


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Rheumatology (Oxford)Home page
J. C. Buckland-Wright, E. A. Messent, C. O. Bingham III, R. J. Ward, and C. Tonkin
A 2 yr longitudinal radiographic study examining the effect of a bisphosphonate (risedronate) upon subchondral bone loss in osteoarthritic knee patients
Rheumatology, February 1, 2007; 46(2): 257 - 264.
[Abstract] [Full Text] [PDF]

Home page
 ptjournalHome page
M. R Maly, P. A Costigan, and S. J Olney
Contribution of Psychosocial and Mechanical Variables to Physical Performance Measures in Knee Osteoarthritis
Physical Therapy, December 1, 2005; 85(12): 1318 - 1328.
[Abstract] [Full Text] [PDF]

Home page
 Rheumatology (Oxford)Home page
B. D. Jackson, A. J. Teichtahl, M. E. Morris, A. E. Wluka, S. R. Davis, and F. M. Cicuttini
The effect of the knee adduction moment on tibial cartilage volume and bone size in healthy women
Rheumatology, March 1, 2004; 43(3): 311 - 314.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. Sports. Med.Home page
A Teichtahl, A Wluka, and F M Cicuttini
Abnormal biomechanics: a precursor or result of knee osteoarthritis?
Br. J. Sports Med., August 1, 2003; 37(4): 289 - 290.
[Full Text] [PDF]

Home page
 Ann Rheum DisHome page
T Miyazaki, M Wada, H Kawahara, M Sato, H Baba, and S Shimada
Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis
Ann Rheum Dis, July 1, 2002; 61(7): 617 - 622.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (47)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Wada, M.
Right arrow Articles by Nose, Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wada, M.
Right arrow Articles by Nose, Y.
Related Collections
Right arrow Osteoarthritis and Cartilage
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?