Quadriceps weakness and osteoarthritis of the knee.
BACKGROUND
The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis.


OBJECTIVE
To explore the relation between lower-extremity weakness and osteoarthritis of the knee.


METHODS
Cross-sectional prevalence study.


METHODS
Population-based, with recruitment by random-digit dialing.


METHODS
462 volunteers 65 years of age or older.


METHODS
Radiographs of the knee were graded for the presence of osteoarthritis. Knee pain and function were assessed with the Western Ontario and McMaster Universities Arthritis Index, the strength of leg flexors and extensors was assessed with isokinetic dynamometry, and lower-extremity lean tissue mass was assessed with dual-energy x-ray absorptiometry.


RESULTS
Among participants with osteoarthritis, quadriceps weakness, but not hamstring weakness, was common. The ratio of extensor strength to body weight was approximately 20% lower in those with than in those without radiographic osteoarthritis. Notably, among women with tibiofemoral osteoarthritis, extensor weakness was present in the absence of knee pain and was seen in participants with normal lower-extremity lean mass (extensor strength, 30.1 lb-ft for those with osteoarthritis and 34.8 lb-ft for those without osteoarthritis; P < 0.001). After adjustment for body weight, age, and sex, lesser quadriceps strength remained predictive of both radiographic and symptomatic osteoarthritis of the knee (odds ratio for prevalence of osteoarthritis per 10 lb-ft loss of strength, 0.8 [95% CI, 0.71 to 0.90] for radiographic osteoarthritis and 0.71 [CI, 0.51 to 0.87] for symptomatic osteoarthritis).


CONCLUSIONS
Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee.
Slemenda
C
C
Indiana University School of Medicine, Indianapolis, USA.
Brandt
K D
KD
Heilman
D K
DK
Mazzuca
S
S
Braunstein
E M
EM
Katz
B P
BP
Wolinsky
F D
FD
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001835:Body Weight; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D007866:Leg / Q000503:physiopathology; D008297:Male; D018908:Muscle Weakness / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000503:physiopathology; D016017:Odds Ratio; D010003:Osteoarthritis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D010146:Pain / Q000209:etiology; D015995:Prevalence; D011859:Radiography
D000894:Anti-Inflammatory Agents, Non-Steroidal