Doctor of Philosophy
Health and Rehabilitation Sciences
Birmingham, Trevor B
Appleton, Christopher Thomas
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.
Summary for Lay Audience
Knee osteoarthritis (OA) is a chronic disease that effects the entire joint and leads to disability and reduces quality of life. Understanding the connection between mechanical and inflammatory processes that drive the disease process will help us to improve treatments for patients with knee OA.
Chapter 2 measures the association between knee pain and knee joint loading in patients with medial compartment knee OA and is largely independent of knee inflammation. Our findings also suggest that there may be a potential interaction between pain and moderate-to-high grade knee inflammation.
Chapter 3 explores the relationship between treating knee inflammation in patients with knee OA (fluid removal and corticosteroid injection) and knee joint loading after 3 weeks. The results of this study suggest that reducing inflammation is associated with improved knee joint loading.
Chapter 4 evaluates the interaction between knee inflammation and knee joint loading and their association with knee OA progression measured as joint space narrowing. The association between knee joint loading and knee OA disease progression was dependent on presence of knee synovitis.
Overall, these findings suggest that there is a link between knee inflammation and joint loading. Further studying these variables to understand their complex relationships will help us to better serve patients with knee OA in the future.
Pinto, Ryan, "Investigating the Effects of Knee Pain and Inflammation on Joint Loading and Osteoarthritis Disease Progression" (2023). Electronic Thesis and Dissertation Repository. 9559.
Available for download on Wednesday, April 30, 2025