Comparison of Maximum Isometric Strength of the Hip Joint Abductor and Knee Joint Extensor Muscles between Knee Osteoarthritis Patients with and without Self-reported Instability

Abstract

Background

Patients with knee osteoarthritis (KOA) often have impaired muscle function of the weight-bearing muscles, particularly in the knee and hip joints. This can lead to a significant loss of strength and power and may play a role in the perceived instability of the knee joint. The purpose of this study was to compare the maximum isometric strength of the hip abductor and knee extensor muscles between patients with KOA with and without perceived instability.

Methods

Nineteen patients with KOA participated in this cross-sectional study and were divided into two groups. The first group (n = 10; women = 4, men = 6, mean age = 67.4 ± standard deviation [SD] 6.4 years) consisted of patients with self-reported instability in the knee joint, and the second group (n = 9; women = 5, men = 4, mean age = 69.6 ± SD 6.7 years) consisted of patients without self-reported instability. Functional and activity limitations were quantified using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Maximum isometric strength of the hip abductors and knee extensors was measured using a belt-mounted handheld dynamometer and expressed as torque (Newton meters [Nm]) by multiplication with the determined lever arm. Torque was normalized to body weight and height.

Results

Patients with instability (median WOMAC score = 68) achieved a significantly lower mean torque in hip abduction than the patients without instability (median WOMAC score = 39) (p = 0.01; Cohen’s d = 1.31). There was no significant difference in knee extension torque between the groups (p = 0.202; Cohen’s d = 0.58).

Conclusion

KOA patients with instability were able to develop significantly lower hip abductor strength than those without instability, suggesting that targeted strength training of this muscle group may be important for this group of patients.

Zusammenfassung

Hintergrund

Patienten mit Kniearthrose (KOA) haben häufig eine eingeschränkte Muskelfunktion der gewichtstragenden Muskeln, insbesondere in den Knie- und Hüftgelenken. Dies kann zu einem erheblichen Verlust an Kraft und Leistungsfähigkeit führen und eine Rolle bei der wahrgenommenen Instabilität des Kniegelenks spielen. Ziel dieser Studie war es, die maximale isometrische Kraft der Hüftabduktoren und Knieextensoren bei Patienten mit KOA mit und ohne wahrgenommene Instabilität zu vergleichen.

Methoden

19 Patienten mit KOA nahmen an dieser Querschnittsstudie teil und wurden in 2 Gruppen eingeteilt. Die 1. Gruppe (n = 10; Frauen = 4, Männer = 6, mittleres Alter = 67,4 ± Standardabweichung [SD] 6,4 Jahre) bestand aus Patienten mit selbst berichteter Kniegelenkinstabilität, die 2. Gruppe (n = 9; Frauen = 5, Männer = 4, mittleres Alter = 69,6 ± SD 6,7 Jahre) bestand aus Patienten ohne selbst berichtete Instabilität. Die Funktions- und Aktivitätseinschränkungen wurden mit dem Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) quantifiziert. Die maximale isometrische Kraft der Hüftabduktoren und Knieextensoren wurde mit einem Handdynamometer, das mit einem Gurt fixiert wurde, gemessen und durch Multiplikation mit dem ermittelten Hebelarm als Drehmoment (Newtonmeter [Nm]) ausgedrückt. Das Drehmoment wurde auf das Körpergewicht und die Körpergröße normiert.

Ergebnisse

Patienten mit Instabilität (Median WOMAC-Score = 68) erreichten ein signifikant geringeres mittleres Drehmoment in Hüftabduktion als Patienten ohne Instabilität (Median WOMAC-Score = 39; p = 0,01; Cohens d = 1,31). Beim Drehmoment in Knieextension gab es keinen signifikanten Unterschied zwischen den Gruppen (p = 0,202; Cohens d = 0,58).

Schlussfolgerung

KOA-Patienten mit Instabilität konnten eine signifikant geringere Hüftabduktionskraft entwickeln als Patienten ohne Instabilität, was darauf hindeutet, dass ein gezieltes Krafttraining dieser Muskelgruppe für diese Patientengruppe wichtig sein könnte.

Keywords

osteoarthritis - instable knee joint - lower extremity muscle strength - patient reported outcome - assessment

Schlüsselwörter

Arthrose - instabiles Kniegelenk - Muskelkraft der unteren Extremitäten - patientenberichtetes Therapieergebnis - Bewertung

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