TY - JOUR
T1 - Varus Thrust and Incident and Progressive Knee Osteoarthritis
AU - Sharma, Leena
AU - Chang, Alison H.
AU - Jackson, Rebecca D.
AU - Nevitt, Michael
AU - Moisio, Kirsten C.
AU - Hochberg, Marc
AU - Eaton, Charles
AU - Kwoh, C. Kent
AU - Almagor, Orit
AU - Cauley, Jane
AU - Chmiel, Joan S.
N1 - Funding Information:
This article was prepared using an Osteoarthritis Initiative (OAI) public-use data set, and its contents do not necessarily reflect the opinions or views of the OAI Study Investigators, the NIH, or the private funding partners of the OAI. The OAI is a public–private partnership between the NIH (contracts N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262) and private funding partners (Merck Research Laboratories, Novartis Pharmaceuticals, GlaxoSmithKline, and Pfizer, Inc.) and is conducted by the OAI Study Investigators. Private sector funding for the OAI is managed by the Foundation for the NIH. The authors of this article are not part of the OAI investigative team.
Funding Information:
Supported by the NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases grants R01-AR-052918, R01-AR-065473, and P60-AR-064464) and the Osteoarthritis Initiative.
PY - 2017/11
Y1 - 2017/11
N2 - Objective: To determine if varus thrust, a bowing out of the knee during gait (i.e., the first appearance or worsening of varus alignment during stance), is associated with incident and progressive knee osteoarthritis (OA), we undertook an Osteoarthritis Initiative ancillary study. We further considered hypothesized associations adjusted for static alignment, anticipating some attenuation. Methods: Gait was observed for the presence of thrust by 1 of 2–3 examiners per study site at 4 sites. In eligible knees, incident OA was defined as subsequent incident Kellgren/Lawrence grade ≥2, whole- and partial-grade medial joint space narrowing (JSN), and annualized loss of joint space width (JSW); progression was defined as medial JSN and JSW loss. Outcome measures were assessed for up to 7 years of follow-up. Analyses were knee-level, using multivariable logistic and linear regression with generalized estimating equations to account for between-limb correlation. Results: The incident OA sample included 4,187 knees (2,610 persons); the progression sample included 3,421 knees (2,284 persons). In knees with OA, thrust was associated with progression as assessed by each outcome measure, with adjustment for age, sex, body mass index, and pain on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. In knees without OA, varus thrust was not associated with incident OA or other outcomes. After adjustment for alignment, the thrust–progression association was attenuated, but an independent association persisted for partial-grade JSN and JSW loss outcome models. WOMAC pain and alignment were consistently associated with all outcome measures. Within the stratum of varus knees, thrust was associated with an increased risk of progression. Conclusion: Varus thrust visualized during gait is associated with knee OA progression and should be a target of intervention development.
AB - Objective: To determine if varus thrust, a bowing out of the knee during gait (i.e., the first appearance or worsening of varus alignment during stance), is associated with incident and progressive knee osteoarthritis (OA), we undertook an Osteoarthritis Initiative ancillary study. We further considered hypothesized associations adjusted for static alignment, anticipating some attenuation. Methods: Gait was observed for the presence of thrust by 1 of 2–3 examiners per study site at 4 sites. In eligible knees, incident OA was defined as subsequent incident Kellgren/Lawrence grade ≥2, whole- and partial-grade medial joint space narrowing (JSN), and annualized loss of joint space width (JSW); progression was defined as medial JSN and JSW loss. Outcome measures were assessed for up to 7 years of follow-up. Analyses were knee-level, using multivariable logistic and linear regression with generalized estimating equations to account for between-limb correlation. Results: The incident OA sample included 4,187 knees (2,610 persons); the progression sample included 3,421 knees (2,284 persons). In knees with OA, thrust was associated with progression as assessed by each outcome measure, with adjustment for age, sex, body mass index, and pain on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. In knees without OA, varus thrust was not associated with incident OA or other outcomes. After adjustment for alignment, the thrust–progression association was attenuated, but an independent association persisted for partial-grade JSN and JSW loss outcome models. WOMAC pain and alignment were consistently associated with all outcome measures. Within the stratum of varus knees, thrust was associated with an increased risk of progression. Conclusion: Varus thrust visualized during gait is associated with knee OA progression and should be a target of intervention development.
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U2 - 10.1002/art.40224
DO - 10.1002/art.40224
M3 - Article
C2 - 28772066
AN - SCOPUS:85032360419
VL - 69
SP - 2136
EP - 2143
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
SN - 2326-5191
IS - 11
ER -