Association between progression of knee osteoarthritis pathology and gait changes over two years: Data from the IMI-APPROACH cohort

Objective

Gait alterations in knee osteoarthritis (OA) patients are potentially related to structural progression of joint tissues, of which some are modifiable. The current objective was to determine whether progression in individual OA pathologies is related to gait kinematic parameters in knee OA patients, and whether these changes are influenced by pain.

Design

Range of motion (ROM) during gait, joint tissue pathologies and morphology from index knee radiographs and MRI, and WOMAC pain were collected at baseline and at two-years in the IMI-APPROACH clinical knee OA cohort. Principal component (PC) analysis was performed on two-year change in gait parameters; the resulting (first) PC was compared between progressors and non-progressors for each structural parameter. When the PC indicated differences between groups (p < 0.1), individual gait parameters were compared for that structural outcome. Statistically significant differences in individual gait parameters were corrected for pain change.

Results

191 patients (age 66.5 ± 6.7; BMI 27.5 ± 4.8; 76 % female; 51 % Kellgren-Lawrence grade ≥2) were analyzed. The gait change PC differed between progressors and non-progressors for meniscal extrusion, bone marrow lesions (BMLs), and patellofemoral cartilage lesions. Further, meniscal extrusion progressors showed significantly more knee ROM and calf ROM decrease, BML progressors worsened more in thigh ROM, and patellofemoral cartilage lesion progressors improved in knee ROM. BML results were no longer significant after pain change adjustment (p = 0.054).

Conclusions

Meniscal extrusion and BML progression are associated with gait worsening, though for BMLs the effect might be influenced by pain.