Knee loading and joint pain during daily activities in people with knee osteoarthritis: A systematic review and meta-analysis

Background Knee loading is associated with the severity and progression of knee osteoarthritis, while knee pain contributes to reduced functional ability and quality of life. In this systematic review, we quantified knee loading and knee pain during different daily activities in people with knee osteoarthritis and explored methodological reasons for differences between studies. Methods PubMed, Web of Science, Scopus, and manual searches were performed up to July 2024, to retrieve studies measuring knee loading and knee pain in walking, sit-to-stand and stair climbing of people with knee osteoarthritis. Descriptive data synthesis and meta-analysis were performed using a mixed-effect model. Findings 183 studies were included. Walking led to the greatest knee loading, followed by stair climbing and finally sit-to-stand, although only sit-to-stand was significantly lower than the others (p < 0.001). Stair ascent had the greatest knee pain, followed by walking, stair descent and then sit-to-stand. In addition, our results show a strong negative correlation between knee loading and pain during walking (r = -0.507). Interpretation The trend of knee loading across activities, while non-significant, is consistent with our previous experimental study. The differences compared to other studies are likely be due to the high heterogeneity in the tested population and differences in methodology. Additionally, there were a substantial number of studies only examining a single activity (primarily walking), which could bias the results. Therefore, future studies should detail participant characteristic and experiment design. In addition, inclusion of a control group is recommended to account for knee loading offsets when comparing results across studies.