INTER-LIMB STRENGTH SYMMETRY AND RISK OF TOTAL KNEE ARTHROPLASTY: A SURVIVAL ANALYSIS
Bibliographic record
Abstract
The purpose of this study was to investigate the relationship of knee extension strength symmetry status (symmetrical versus asymmetrical) to the risk of undergoing total knee arthroplasty (TKA) among participants with or at risk for knee osteoarthritis in the Osteoarthritis Initiative (OAI). Participants were selected from the OAI, a multi-center, longitudinal, cohort, including 4796 individuals with or at risk for knee osteoarthritis. All participants had complete data for baseline bilateral knee extension strength (collected isometrically at 60deg from full extension) and TKA date, if applicable. Only the first TKA was used for participants with bilateral TKA dates. All strength values were normalized to body mass (N/kg). Strength symmetry-index values were calculated for knee extension using the formula ((XR-XL)/(0.5(XR+XL))*100). A ±10% threshold was set to indicate asymmetry between limbs. Participants were grouped based on knee extension strength symmetry. A SI of ≥ +10% indicated greater strength in their right limb, a SI between -9.9 to +9.9 was considered symmetric, and a SI of ≤ -10% indicated greater strength in their left limb. The relationship between knee extension strength symmetry status and TKA was examined using Kaplan-Meier curves to evaluate survival based on the Mantel-Cox log-rank test. Multivariable Cox regression models were adjusted for age, sex, BMI, baseline Kellgren-Lawrence (KL) grades and baseline pain to determine the multivariable-adjusted hazard ratios (aHRs) of TKA in symmetrical versus asymmetrical (SI = ≥ +10% and ≤ -10%) participants. Limb-specific aHRs were also calculated for risk of right and left TKA separately. In 3877 participants over 10-years, 373 first limb TKAs were performed (192 right limb and 181 left limb). Log-rank tests indicated that the distribution of TKAs across symmetry status was significantly different (p In conclusion, knee extension strength asymmetry may be an easily accessible and useful clinical measure to identify individuals at increased risk for progression to TKA. Interventions targeting not only muscle strength of the affected limb, but the symmetry between limbs, may improve clinical outcomes. Further work to understand the dynamics of asymmetry over time is needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".