Gait variability and motor control in patients with knee osteoarthritis as measured by the uncontrolled manifold technique

Knee osteoarthritis (OA) causes pain, reduced muscular strength and stiffness of the affected joint. In response, the motor control mechanism is altered, potentially compromising stability during acts of daily living. Reduced walking stability can be quantified in terms of gait variability. This study therefore aimed to identify and quantify the effects of knee arthritis on gait variability. Fifty adults (25 males/25 females) with end-stage OA of the knee sufficiently symptomatic to require joint replacement, walked on a self-paced treadmill for 2 min. A motion capture system was used to record 50 consecutive gait cycles from each patient. Kinematic variability of gait was analysed using the uncontrolled manifold technique (UCM). The position of the centre of mass (COM) was chosen as the task variable for the analysis. Results showed that our patient cohort were able to maintain a stable COM whilst walking, through adopting variable combinations of hip, knee and ankle kinematics. The greatest magnitudes of instability (based on the UCM ratios) occurred during initial contact and terminal stance. Active extension of the knee joint to approximately 5° is required during these gait cycle events, meaning that these gait events are highly quadriceps dependent. This study identified and quantified components of the gait cycle where patients with knee OA are most unstable. Employment of this technique could therefore allow specific personalised prescription for prehabilitation and rehabilitation.