Ann Rehabil Med.  2011 Oct;35(5):701-709. 10.5535/arm.2011.35.5.701.

Balance Control and Knee Osteoarthritis Severity

• Kim HS
• Yun DH
• Yoo SD
• Kim DH
• Jeong YS
• Yun JS
• Hwang DG
• Jung PK
• Choi SH

• KMID: 2267233
• DOI: http://doi.org/10.5535/arm.2011.35.5.701

Abstract

OBJECTIVE
To investigate balance control according to the severity of knee osteoarthritis (OA) using clinical tests and Tetra-ataxiometric posturography (Tetrax(R)). METHOD: A total 80 patients with primary knee OA classified according to American College of Rheumatology criteria, and 40 age-matched controls were enrolled in this study. Of those with OA, 39 patients had mild OA (Kellgren-Lawrence [KL] grade 1, 2) and the other 41 had moderate to severe OA (KL grade 3, 4). The postural control capabilities of the subjects were assessed using the timed up and go test (TUG), Berg balance scale (BBS), and Tetrax(R), which utilizes two paired force plates to measure vertical pressure fluctuations over both heels and forefeet. The subjects were checked for their stability index (ST), Fourier index, weight distribution index (WDI), and synchronization index (SI) in eight positions using Tetrax(R).
RESULTS
Patients with moderate to severe OA exhibited significantly higher stability indices in all positions than patients with mild OA. The Fourier index was also higher in patients with moderate to severe OA than in patients with mild OA. However, the weight distribution index and synchronization of both heels and forefeet were not significantly different in the three groups.
CONCLUSION
These findings suggest that patients with moderate to severe OA have more deficits in balance control than those with mild disease. Therefore, evaluation of balance control and education aimed at preventing falls would be useful to patients with knee OA.

Keyword

Knee osteoarthritis; Balance control; Posturography; Fall

MeSH Terms

Heel
Humans
Knee
Osteoarthritis, Knee
Rheumatology

Figure

• 

  Fig. 1 Tetra-ataxiometric posturography Tetrax® (A) postural stability in a patient with knee OA using Tetrax® (B)

Reference

1. Hassan BS, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis. 2001; 60:612–618. PMID: 11350851.

2. Brandt KD, Dieppe P, Radin EL. Etiopathogenesis of osteoarthritis. Rheum Dis Clin North Am. 2008; 34:531–539. PMID: 18687271.

3. Martel-Pelletier J. Pathophysiology of osteoarthritis. Osteoarthritis Cartilage. 1998; 6:374–376. PMID: 10343769.

4. Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Joint Surg Br. 1991; 73:53–56. PMID: 1991775.

5. Marks R, Quinney HA, Wessel J. Proprioceptive sensibility in women with normal and osteoarthritic knee joints. Clin Rheumatol. 1993; 12:170–175. PMID: 8358974.

6. Pandya NK, Draganich LF, Mauer A, Piotrowski GA, Pottenger L. Osteoarthritis of the knees increases the propensity to trip on an obstacle. Clin Orthop Relat Res. 2005; 431:150–156. PMID: 15685069.

7. Lee KM, Kang JW, Han SH. Evaluation of standing balance in hemiplegic patients using the functional reach test. J Korean Acad Rehabil Med. 2002; 26:647–651.

8. Lee JJ, Lee HJ, Park JH, Han EY, Kim MJ, Jung HY. The Korean version of berg balance scale as an index of activity related to ambulation in subjects with stroke. J Korean Acad Rehabil Med. 2007; 31:400–403.

9. Jung HY, Park JH, Shim JJ, Kim MJ, Hwang MR, Kim SH. Reliability test of Korean version of berg balance scale. J Korean Acad Rehabil Med. 2006; 30:611–618.

10. Hermodsson Y, Ekdahl C, Persson BM, Roxendal G. Standing balance in trans-tibial amputees following vascular disease or trauma: a comparative study with healthy subjects. Prosthet Orthot Int. 1994; 18:150–158. PMID: 7724348.

11. Oppenheim U, Kohen-Raz R, Alex D, Kohen-Raz A, Azarya M. Postural characteristics of diabetic neuropathy. Diabetes Care. 1999; 22:328–332. PMID: 10333953.

12. Dehner C, Heym B, Maier D, Sander S, Arand M, Elbel M, Hartwig E, Kramer M. Postural control deficit in acute QTF grade whiplash injuries. Gait Posture. 2008; 28:113–119. PMID: 18083031.

13. Kim BR, Choi KH, Chun MH, Lee MC, Chung SJ, Jang KW. Evaluation of balance control in patients with idiopathic Parkinson's disease using tetra-ataxiometric posturography. J Korean Acad Rehabil Med. 2009; 33:538–546.

14. Masui T, Hasegawa Y, Yamaguchi J, Kanoh T, Ishiguro N, Suzuki S. Increasing postural sway in rural-community-dwelling elderly persons with knee osteoarthritis. J Orthop Sci. 2006; 11:353–358. PMID: 16897198.

15. Thorp LE, Sumner DR, Block JA, Moisio KC, Shott S, Wimmer MA. Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. Arthritis Rheum. 2006; 54:3842–3849. PMID: 17133592.

16. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarhritis of the knee. Arthritis Rheum. 1986; 29:1039–1049. PMID: 3741515.

17. Shumway-Cook A, Brauser S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000; 80:896–903. PMID: 10960937.

18. Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995; 27:27–36. PMID: 7792547.

19. Avni N, Avni I, Barenboim E, Azaria B, Zadok D, Kohen-raz R, Morad Y. Brief posturographic test as an indicator of fatigue. Psychiatry Clin Neurosci. 2006; 60:340–346. PMID: 16732751.

20. Kohen-Raz R. Application of tetra-ataxiametric posturography in clinical and developmental diag nosis. Percept Mot Skills. 1991; 73:635–656. PMID: 1766798.

21. Yoshida S, Aoyagi K, Felson DT, Aliabadi P, Shindo H, Takemoto T. Comparison of the prevalence of radiographic osteoarthritis of the knee and hand between Japan and the United States. J Rheumatol. 2002; 29:1454–1458. PMID: 12136905.

22. Gardner MM, Robertson MC, Campbell AJ. Exercise in preventing falls and fall related injuries in older people: a review of randomized controlled trials. Br J Sports Med. 2000; 34:7–17. PMID: 10690444.

23. Barnett A, Smith B, Lord SR, Williams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomized controlled trial. Age Ageing. 2003; 32:407–414. PMID: 12851185.