Buckling in the Iranian Patients with Knee Osteoarthritis: Its Frequency and Correlation with Physical Activities and Falling

Document Type: Original Article

Authors

1 Associate Professor, Sports Medicine Department, Iran University of Medical Sciences, Tehran, Iran

2 M.D. Iran University of Medical Sciences, Tehran, Iran

3 Assistant of Sports Medicine, Sports Medicine Department, Iran University of Medical Sciences, Tehran, Iran

Abstract

Introduction:Knee osteoarthritis (KOA), one of the most common articular diseases, sometimes leads to severe disability. This study aimed to estimate the prevalence of knee-buckling in patients with KOA during the past three months and to investigate its relation with the physical function.
Methods:A cross-sectional study was performed on 190 patients with KOA. Two checklists and WOMAC questionnaire were completed by the participants. The patients’ function was evaluated by timed up and go (TUG) and six-minute walk tests (6MWT). Comparison between the two groups of patients with and without buckling was done using independent t-test and the correlations were analyzed between the variables using K square and Pearson correlation tests.
Results:Eighty three patients (43.68%) had a history of buckling in the past 3 months. Knee-buckling frequency was 40.87% and 48% in women and men, respectively. Statistical analysis showed significant differences between pain (p = 0.007), TUG (p =0.0001), 6MWT (p = 0.0001), WOMAC pain (p= 0.005), WOMAC stiffness (p = 0.006) and total WOMAC scores (p=0.03) concerning the two groups with and without buckling. There was a significant correlation between buckling with gender (ρ= 0.72, p=0.025), KOA history (p=0.67, p= 0.033) and the rate of fall (ρ=0.87, p=0 .012). Moreover, there were reverse significant correlations between the history of buckling with WOMAC score (r= - 0.51, p=0.02) and the functional tests results including TUG (r= - 0.57, p=0.0001) and 6MWT
(r= - 0.67, p=0.0001).
Conclusion:The results indicated a prevalence of 43.68% buckling among the patients which was associated with their functional impairment.

Keywords


  1. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage 2013; 21(9):1145-53.
  2. Felson DT, Niu J, McClennan C, Sack B, Aliabadi P, Hunter DJ, et al. Knee buckling: prevalence, risk factors, and associated limitations in function. Ann Intern Med 2007; 147(8):534-40.
  3. Fitzgerald GK, Piva SR, Irrgang JJ. Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum 2004; 51(6):941-6.
  4. Knoop J, Van Der Leeden M, Van Der Esch M, Thorstensson CA, Gerritsen M, Voorneman RE, et al. Association of lower muscle strength with self‐reported knee instability in osteoarthritis of the knee: results from the Amsterdam Osteoarthritis Cohort. Arthritis Care Res (Hoboken) 2012; 64(1):38-45.
  5. Cummings JR, Pedowitz RA. Knee instability: the orthopedic approach. Semin Musculoskelet Radiol 2005; 9(1):5-16.
  6. Segal NA, Nevitt MC, Welborn RD, Nguyen US, Niu J, Lewis CE, et al. The association between antagonist hamstring coactivation and episodes of knee joint shifting and buckling. Osteoarthritis Cartilage 2015; 23(7):1112-21.
  7. Schmitt LC, Fitzgerald GK, Reisman AS, Rudolph KS. Instability, laxity, and physical function in patients with medial knee osteoarthritis. Phys Ther 2008; 88(12):1506-16.
  8. Lewek MD, Rudolph KS, Snyder-Mackler L. Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis. Osteoarthritis Cartilage 2004; 12(9):745-51.
  9. Nguyen US, Felson DT, Niu J, White DK, Segal NA, Lewis CE, et al. The impact of knee instability with and without buckling on balance confidence, fear of falling and physical function: the Multicenter Osteoarthritis Study. Osteoarthritis Cartilage 2014; 22(4):527-34.
  10. Sharma L, Chmiel JS, Almagor O, Moisio K, Chang AH, Belisle L, et al. Knee instability and basic and advanced function decline in knee osteoarthritis. Arthritis Care Res (Hoboken) 2015; 67(8):1095-102.
  11. Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, et al. Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheum 2006; 55(4):610-5.
  12. Dobson F, Hinman R, Roos EM, Abbott J, Stratford P, Davis AM, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage 2013; 21(8):1042-52.
  13. Hawker GA, Croxford R, Bierman AS, Harvey PJ, Ravi B, Stanaitis I, et al. All-cause mortality and serious cardiovascular events in people with hip and knee osteoarthritis: a population based cohort study. PLoS One 2014; 9:(3):e91286.
  14. Fitzgerald GK, Piva SR, Irrgang JJ. Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum 2004; 51(6):941-6.
  15. Bennell K, Dobson F, Hinman R. Measures of physical performance assessments: Self‐Paced Walk Test (SPWT), Stair Climb Test (SCT), Six‐Minute Walk Test (6MWT), Chair Stand Test (CST), Timed Up & Go (TUG), Sock Test, Lift and Carry Test (LCT), and Car Task. Arthritis Care Res (Hoboken) 2011; 63(Supple 11): S350-70.
  16. Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Keshtan FG, Hoseini HA, Mazloumi SM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in persian speaking patients with knee osteoarthritis. Arch Bone Jt Surg 2014; 2(1):57-62.
  17. van der Esch M, Knoop J, van der Leeden M, Voorneman R, Gerritsen M, Reiding D, et al. Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort. Clin Rheumatol 2012; 31(10):1505-10.
  18. Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum 2010; 40(3):250-66.
  19. Hart JM, Pietrosimone B, Hertel J, Ingersoll CD. Quadriceps activation following knee injuries: a systematic review. J Athl Train 2010; 45(1):87-97.
  20. Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L. Mechanisms undlerlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc 2008; 40(3):422-7.
  21. Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 1997; 127(2):97-104.
  22. Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, Sowers MF. Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis. Am J Phys Med Rehabil 2010; 89(7):541-8.
  23. Segal NA, Glass NA, Torner J, Yang M, Felson DT, Sharma L, et al. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage 2010; 18(6):769-75.
  24. Blagojevic M, Jinks C, Jeffery A, Jordan K. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage 2010; 18(1):24-33.
  25. Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammopharmacology 2012; 20(2):53-8.
  26. Lopes KT, Costa DF, Santos LF, Castro DP, Bastone AC. Prevalence of fear of falling among a population of older adults and its correlation with mobility, dynamic balance, risk and history of falls. Braz J Phys Ther 2009; 13(3):223-9.
  27. Gunn AH, Schwartz TA, Arbeeva LS, Callahan LF, Golightly Y, Goode A, et al. Fear of movement and associated factors among adults with symptomatic knee osteoarthritis. Arthritis Care Res (Hoboken) 2017; 69(12):1826-33.
  28. Palo N, Chandel SS, Dash SK, Arora G, Kumar M, Biswal MR. Effects of osteoarthritis on quality of life in elderly population of bhubaneswar, india: a prospective multicenter screening and therapeutic study of 2854 patients. Geriatr Orthop Surg Rehabil 2015; 6(4):269-75.
  29. Romli MH, Tan MP, Mackenzie L, Lovarini M, Suttanon P, Clemson L. Falls amongst older people in Southeast Asia: a scoping review. Public Health 2017; 145:96-112.
  30. Ciolac EG. Exercise training as a preventive tool for age-related disorders: a brief review. Clinics (Sao Paulo) 2013; 68(5):710-7.
  31. Palmieri-Smith RM, Kreinbrink J, Ashton-Miller JA, Wojtys EM. Quadriceps inhibition induced by an experimental knee joint effusion affects knee joint mechanics during a single-legged drop landing. Am J Sports Med 2007; 35(8):1269-75.
  32. Segal NA, Glass NA, Felson DT, Hurley M, Yang M, Nevitt M, et al. The effect of quadriceps strength and proprioception on risk for knee osteoarthritis. Med Sci Sports Exerc 2010; 42(11):2081-8.