Biomechanical Deviations During Level Walking Associated With Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Objective. To identify which gait deviations are consistently associated with knee osteoarthritis (KOA) and how these are influenced by disease severity, the involved compartment, and sex. Methods. Five electronic databases and reference lists of publications were searched. Cross-sectional, observational studies comparing temporospatial variables, joint kinematics, and joint moments between individuals with KOA and healthy controls or between KOA subgroups were considered for review. Only publications scoring 50% on a modified methodology quality index were included. Because of the number of gait deviations examined, only biomechanical variables reported by 4 publications were further analyzed. Where possible, a meta-analysis was performed using effect sizes (ES) calculated from discrete variables. Results. In total, 41 publications examining 20 variables were included. The majority of consistent gait deviations associated with KOA were exhibited by those with severe disease in the temporospatial domain. Individuals with severe KOA exhibited greater stride duration than controls (ES 1.35 [95% confidence interval (95% CI) 1.03, 1.67]) and a decrease in cadence (ES -0.75 [95% CI -1.12, -0.39]) compared with controls. The evidence for kinematic and joint moment change was primarily limited or conflicting. There was a lack of evidence for alterations in the external knee adduction moment. Conclusion. Individuals with KOA exhibit a range of gait deviations compared with controls. Despite its common usage in KOA gait studies, we did not find consistent evidence that knee adduction moment differs between those with and without KOA or between disease severity levels. Further research examining the reasons for a lack of difference in many gait variables in those with knee OA is needed.