Investigating the Effects of Knee Pain and Inflammation on Joint Loading and Osteoarthritis Disease Progression
Abstract
Knee osteoarthritis (OA) is a progressive condition affecting the whole joint with biomechanical and biological factors playing a role in the pathogenesis of the disease. As there is no known cure currently, a mainstay of treatment involves modifying symptoms. Research has been focused on assessing the effectiveness of treatments and exploring the role that modifiable risk factors play in disease progression.
Chapter 2 is a cross-sectional study that evaluates the associations between pain, knee synovitis and gait biomechanics in patients with knee OA. We divided patients into groups of low and moderate-to-severe pain. Our findings suggest that pain is associated with altered joint loading in patients with knee OA and is largely independent of synovitis level. We also found that there may be a potential interaction between pain and synovitis in patients with moderate-to-severe synovitis.
Chapter 3 explores the association between knee synovitis treatment, through knee aspiration and glucocorticoid injection, and gait biomechanics and strength 3 weeks post-treatment. Sagittal plane knee moments and isokinetic knee flexion and extension strength improved after knee aspiration and glucocorticoid injection in patients with knee OA and synovitis. Inflammation and pain both contributed to increases in strength seen after treatment.
Chapter 4 studies the interactions between baseline knee synovitis and gait biomechanics on knee OA radiographic disease progression after 2 years. Our results show that the association between sagittal plane joint moments during gait and knee OA disease progression is dependent on the level of knee synovitis that is present.
Overall, this thesis provides evidence that pain is associated with gait biomechanics, predominantly sagittal plane knee moments. By reducing knee inflammation, we can alter knee joint loading. Furthermore, there is an interconnection between inflammation and knee joint loading on the progression of disease. Future research that is studying gait biomechanics in patients with knee OA should incorporate measures of knee inflammation to gain a more robust understanding of the disease process.