Patients with knee osteoarthritis can be divided into subgroups based on tibiofemoral joint kinematics of gait - an exploratory and dynamic radiostereometric study.

OBJECTIVE: Patients with advanced knee osteoarthritis (KOA) frequently alter their gait patterns in an attempt to alleviate symptoms. Understanding the underlying pathomechanics and identifying KOA phenotypes are essential to improve treatments. We investigated kinematics in patients with KOA to identify subgroups of homogeneous knee joint kinematics. METHOD: A total of 66 patients with symptomatic KOA scheduled for total knee arthroplasty and 15 age-matched healthy volunteers with asymptomatic, non-arthritic knees were included. We used k-means clustering to divide patients into subgroups based on dynamic radiostereometry-assessed tibiofemoral joint kinematics. Clinical characteristics such as knee ligament lesions and KOA scores were graded by magnetic resonance imaging and radiographs, respectively. RESULTS: We identified four clusters that were supported by clinical characteristics. The flexion group (n = 20) consisted primarily of patients with medial KOA. The abduction group (n = 17) consisted primarily of patients with lateral KOA. The anterior draw group (n = 10) was composed of patients with medial KOA, some degree of anterior cruciate ligament lesion and the highest KOA score. The external rotation group (n = 19) primarily included patients with medial collateral and posterior cruciate ligament lesions. CONCLUSION: Based on tibiofemoral gait patterns, patients with advanced KOA can be divided into four subgroups with specific clinical characteristics and different KOA-affected compartments. The findings add to our understanding of how knee kinematics may affect the patient's development of different types of KOA. This may inspire improved and more patient-specific treatment strategies in the future.

Exposure assessment of kneeling work activities among floor layers.

The objective of this study was to quantify the proportion of kneeling work activities among floor layers and to assess external knee joint forces in five different kneeling work positions. Thirty-three floor layers were videotaped discontinuously and four floor layers were videotaped continuously for a whole working day. External knee forces were measured in five different kneeling work positions in ten floor layers using Computer Dynography. The study showed that floor layers spent a high percentage of time in knee-straining work positions. Kneeling work tasks, particularly gluing and crawling caused high external knee forces ranging from 0.3 Newton (SD 0.2) times body weight when floor layers were kneeling back on the heels, to 3.5 Newton (SD 0.3) times body weight in the crawling work position. The study highlights the need for prevention by minimizing the amount of kneeling work positions among floor layers.