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. 2004 Apr;63(4):402–407. doi: 10.1136/ard.2003.007583

Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later

C Thorstensson 1, I Petersson 1, L Jacobsson 1, T Boegard 1, E Roos 1
PMCID: PMC1754965  PMID: 15020334

Abstract

Background: Reduced quadriceps strength is an early finding in subjects with knee osteoarthritis, but it is not clear whether it is a cause or a consequence of knee osteoarthritis.

Objective: To determine whether reduced functional performance in the lower extremity predicts the incidence or progression of radiographic knee osteoarthritis.

Design: Prospective, epidemiological, population based cohort study.

Patients: 148 subjects (62 women), aged 35–54 (mean 44.8), with chronic knee pain from a population based cohort.

Measurements: Predictors analysed were age, sex, body mass index, baseline knee pain, and three tests of lower extremity functional performance: maximum number of one-leg rises from sitting, time spent walking 300 m, and timed standing on one leg. Weightbearing tibiofemoral knee radiographs were obtained at baseline and after 5 years (median 5.1, range 4.2–6.1), and classified according to Kellgren and Lawrence as no osteoarthritis (Kellgren and Lawrence = 0, n = 94) or prevalent osteoarthritis (Kellgren and Lawrence ⩾1, n = 54).

Results: Fewer one-leg rises (median 17 v 25) predicted incident radiographic osteoarthritis five years later (OR 2.6, 95% CI 1.1 to 6.0). The association remained significant after controlling for age, sex, body mass index, and pain. No significant predictor of radiographic progression in the group with prevalent osteoarthritis was found.

Conclusion: Reduced functional performance in the lower extremity predicted development of radiographic knee osteoarthritis 5 years later among people aged 35–55 with chronic knee pain and normal radiographs at baseline. These findings suggest that a test of one-leg rises may be useful, and interventions aimed at improving functional performance may be protective against development of knee osteoarthritis.

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Figure 1 .

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Flow from sample of population at baseline to study cohort at follow up.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boegård T. L., Rudling O., Petersson I. F., Jonsson K. Magnetic resonance imaging of the knee in chronic knee pain. A 2-year follow-up. Osteoarthritis Cartilage. 2001 Jul;9(5):473–480. doi: 10.1053/joca.2001.0414. [DOI] [PubMed] [Google Scholar]
  2. Boegård T., Rudling O., Petersson I. F., Jonsson K. Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the tibiofemoral joint. Ann Rheum Dis. 1998 Jul;57(7):401–407. doi: 10.1136/ard.57.7.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Boegård T., Rudling O., Petersson I. F., Sanfridsson J., Saxne T., Svensson B., Jonsson K. Postero-anterior radiogram of the knee in weight-bearing and semiflexion. Comparison with MR imaging. Acta Radiol. 1997 Nov;38(6):1063–1070. doi: 10.1080/02841859709172132. [DOI] [PubMed] [Google Scholar]
  4. Brandt K. D., Heilman D. K., Slemenda C., Katz B. P., Mazzuca S. A., Braunstein E. M., Byrd D. Quadriceps strength in women with radiographically progressive osteoarthritis of the knee and those with stable radiographic changes. J Rheumatol. 1999 Nov;26(11):2431–2437. [PubMed] [Google Scholar]
  5. Buckland-Wright J. C., Wolfe F., Ward R. J., Flowers N., Hayne C. Substantial superiority of semiflexed (MTP) views in knee osteoarthritis: a comparative radiographic study, without fluoroscopy, of standing extended, semiflexed (MTP), and schuss views. J Rheumatol. 1999 Dec;26(12):2664–2674. [PubMed] [Google Scholar]
  6. Cooper C., Snow S., McAlindon T. E., Kellingray S., Stuart B., Coggon D., Dieppe P. A. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000 May;43(5):995–1000. doi: 10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1. [DOI] [PubMed] [Google Scholar]
  7. Deones V. L., Wiley S. C., Worrell T. Assessment of quadriceps muscle performance by a hand-held dynamometer and an isokinetic dynamometer. J Orthop Sports Phys Ther. 1994 Dec;20(6):296–301. doi: 10.2519/jospt.1994.20.6.296. [DOI] [PubMed] [Google Scholar]
  8. Deyle G. D., Henderson N. E., Matekel R. L., Ryder M. G., Garber M. B., Allison S. C. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 2000 Feb 1;132(3):173–181. doi: 10.7326/0003-4819-132-3-200002010-00002. [DOI] [PubMed] [Google Scholar]
  9. Ekdahl C., Jarnlo G. B., Andersson S. I. Standing balance in healthy subjects. Evaluation of a quantitative test battery on a force platform. Scand J Rehabil Med. 1989;21(4):187–195. [PubMed] [Google Scholar]
  10. Fransen M., Crosbie J., Edmonds J. Reliability of gait measurements in people with osteoarthritis of the knee. Phys Ther. 1997 Sep;77(9):944–953. doi: 10.1093/ptj/77.9.944. [DOI] [PubMed] [Google Scholar]
  11. Hart D. J., Doyle D. V., Spector T. D. Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. Arthritis Rheum. 1999 Jan;42(1):17–24. doi: 10.1002/1529-0131(199901)42:1<17::AID-ANR2>3.0.CO;2-E. [DOI] [PubMed] [Google Scholar]
  12. Hart D. J., Spector T. D. Kellgren & Lawrence grade 1 osteophytes in the knee--doubtful or definite? Osteoarthritis Cartilage. 2003 Feb;11(2):149–150. doi: 10.1053/joca.2002.0853. [DOI] [PubMed] [Google Scholar]
  13. Hernborg J., Nilsson B. E. Age and sex incidence of osteophytes in the knee joint. Acta Orthop Scand. 1973;44(1):66–68. doi: 10.3109/17453677308988674. [DOI] [PubMed] [Google Scholar]
  14. Hurley M. V., Scott D. L., Rees J., Newham D. J. Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis. 1997 Nov;56(11):641–648. doi: 10.1136/ard.56.11.641. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hurley M. V. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am. 1999 May;25(2):283-98, vi. doi: 10.1016/s0889-857x(05)70068-5. [DOI] [PubMed] [Google Scholar]
  16. Lankhorst G. J., Van de Stadt R. J., Van der Korst J. K. The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee. Scand J Rehabil Med. 1985;17(4):167–172. [PubMed] [Google Scholar]
  17. Lanyon P., O'Reilly S., Jones A., Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis. 1998 Oct;57(10):595–601. doi: 10.1136/ard.57.10.595. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Larsson A. C., Petersson I., Ekdahl C. Functional capacity and early radiographic osteoarthritis in middle-aged people with chronic knee pain. Physiother Res Int. 1998;3(3):153–163. doi: 10.1002/pri.137. [DOI] [PubMed] [Google Scholar]
  19. Mikesky A. E., Meyer A., Thompson K. L. Relationship between quadriceps strength and rate of loading during gait in women. J Orthop Res. 2000 Mar;18(2):171–175. doi: 10.1002/jor.1100180202. [DOI] [PubMed] [Google Scholar]
  20. Minor M. A., Hewett J. E., Webel R. R., Dreisinger T. E., Kay D. R. Exercise tolerance and disease related measures in patients with rheumatoid arthritis and osteoarthritis. J Rheumatol. 1988 Jun;15(6):905–911. [PubMed] [Google Scholar]
  21. O'Reilly S. C., Jones A., Muir K. R., Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998 Oct;57(10):588–594. doi: 10.1136/ard.57.10.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Oliveria S. A., Felson D. T., Cirillo P. A., Reed J. I., Walker A. M. Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee. Epidemiology. 1999 Mar;10(2):161–166. [PubMed] [Google Scholar]
  23. Petersson I. F., Boegård T., Saxne T., Silman A. J., Svensson B. Radiographic osteoarthritis of the knee classified by the Ahlbäck and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain. Ann Rheum Dis. 1997 Aug;56(8):493–496. doi: 10.1136/ard.56.8.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Radin E. L., Paul I. L., Rose R. M. Role of mechanical factors in pathogenesis of primary osteoarthritis. Lancet. 1972 Mar 4;1(7749):519–522. doi: 10.1016/s0140-6736(72)90179-1. [DOI] [PubMed] [Google Scholar]
  25. Reed R. L., Den Hartog R., Yochum K., Pearlmutter L., Ruttinger A. C., Mooradian A. D. A comparison of hand-held isometric strength measurement with isokinetic muscle strength measurement in the elderly. J Am Geriatr Soc. 1993 Jan;41(1):53–56. doi: 10.1111/j.1532-5415.1993.tb05949.x. [DOI] [PubMed] [Google Scholar]
  26. Slemenda C., Heilman D. K., Brandt K. D., Katz B. P., Mazzuca S. A., Braunstein E. M., Byrd D. Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women? Arthritis Rheum. 1998 Nov;41(11):1951–1959. doi: 10.1002/1529-0131(199811)41:11<1951::AID-ART9>3.0.CO;2-9. [DOI] [PubMed] [Google Scholar]
  27. Spector T. D., Dacre J. E., Harris P. A., Huskisson E. C. Radiological progression of osteoarthritis: an 11 year follow up study of the knee. Ann Rheum Dis. 1992 Oct;51(10):1107–1110. doi: 10.1136/ard.51.10.1107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wolfe Frederick, Lane Nancy E. The longterm outcome of osteoarthritis: rates and predictors of joint space narrowing in symptomatic patients with knee osteoarthritis. J Rheumatol. 2002 Jan;29(1):139–146. [PubMed] [Google Scholar]

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