Study of Patients with Bilateral Knee Osteoarthritis Undergoing Total Knee Replacement Procedure with Coexisting Lumbar Spondylosis Symptoms

Sanjay Bhalchandra Londhe, Ravi Vinod Shah, Meghana Patwardhan, Amit Pankaj Doshi, Shubhankar Sanjay Londhe, Kavita Subhedar, Vishal Kundnani, Jwalant Patel, Sanjay Bhalchandra Londhe, Ravi Vinod Shah, Meghana Patwardhan, Amit Pankaj Doshi, Shubhankar Sanjay Londhe, Kavita Subhedar, Vishal Kundnani, Jwalant Patel

Abstract

Study design: This is a prospective cohort study involving patients who were followed for 2 years after total knee replacement (TKR) to determine changes in lumbar spine and knee symptoms.

Purpose: The objectives of this study were to determine the percentage of patients undergoing bilateral TKR who present with coexisting lumbar spine problems and determine if TKR relieves lumbar spine symptoms.

Overview of literature: No studies quantify the percentage of TKR patients who experience relief of lumbar spine symptoms after TKR surgery.

Methods: The study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively.

Results: All 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p-value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention.

Conclusions: A significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR.

Keywords: Lumbar disc degeneration; Osteoarthritis; Total knee replacement.

Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Specimen of Patient Self Addressed Questionnaire.

References

    1. Fitzgerald JD, Orav EJ, Lee TH, et al. Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum. 2004;51:100–9.
    1. Meding JB, Meding LK, Ritter MA, Keating EM. Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res. 2012;470:144–9.
    1. Vina ER, Hannon MJ, Kwoh CK. Improvement following total knee replacement surgery: exploring preoperative symptoms and change in preoperative symptoms. Semin Arthritis Rheum. 2016;45:547–55.
    1. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–62.
    1. Skou ST, Roos EM, Laursen MB, et al. A randomized, controlled trial of total knee replacement. N Engl J Med. 2015;373:1597–606.
    1. Liang MH, Cullen KE, Larson MG, et al. Cost-effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum. 1986;29:937–43.
    1. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly: the Framingham Osteoarthritis Study. Arthritis Rheum. 1987;30:914–8.
    1. Hicks GE, Morone N, Weiner DK. Degenerative lumbar disc and facet disease in older adults: prevalence and clinical correlates. Spine (Phila Pa 1976) 2009;34:1301–6.
    1. Reginster JY. The prevalence and burden of arthritis. Rheumatology (Oxford) 2002;41(Supp 1):3–6.
    1. Hassett G, Hart DJ, Doyle DV, March L, Spector TD. The relation between progressive osteoarthritis of the knee and long term progression of osteoarthritis of the hand, hip, and lumbar spine. Ann Rheum Dis. 2006;65:623–8.
    1. McNamara MJ, Barrett KG, Christie MJ, Spengler DM. Lumbar spinal stenosis and lower extremity arthroplasty. J Arthroplasty. 1993;8:273–7.
    1. Bohl WR, Steffee AD. Lumbar spinal stenosis: a cause of continued pain and disability in patients after total hip arthroplasty. Spine (Phila Pa 1976) 1979;4:168–73.
    1. Fogel GR, Esses SI. Hip spine syndrome: management of coexisting radiculopathy and arthritis of the lower extremity. Spine J. 2003;3:238–41.
    1. Chang CB, Park KW, Kang YG, Kim TK. Coexisting lumbar spondylosis in patients undergoing TKA: how common and how serious? Clin Orthop Relat Res. 2014;472:710–7.
    1. Wilke HJ, Rohlmann F, Neidlinger-Wilke C, Werner K, Claes L, Kettler A. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: part I. Lumbar spine. Eur Spine J. 2006;15:720–30.
    1. Kapstad H, Hanestad BR, Langeland N, Rustoen T, Stavem K. Cutpoints for mild, moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery. BMC Musculoskelet Disord. 2008;9:55.
    1. Zelman DC, Dukes E, Brandenburg N, Bostrom A, Gore M. Identification of cut-points for mild, moderate and severe pain due to diabetic peripheral neuropathy. Pain. 2005;115:29–36.
    1. Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res. 2006;443:266–72.
    1. Sowers M. Epidemiology of risk factors for osteoarthritis: systemic factors. Curr Opin Rheumatol. 2001;13:447–51.
    1. Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y. A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome. Gait Posture. 2008;28:687–92.
    1. Romano CL, Romano D, Bonora C, Mineo G. Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain. J Orthop Traumatol. 2009;10:185–91.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe