Does Concomitant Low Back Pain Affect Revision Total Knee Arthroplasty Outcomes?

Abstract

The number of revision total knee arthroplasties (rev-TKA) is increasing every year. These cases are technically difficult and add considerable burden on the healthcare system. Many patients have concomitant low back pain that may interfere with functional outcome. We asked whether having low back pain at baseline would influence amount and rate of improvement on standardized outcomes measures after rev-TKA. We retrospectively reviewed 308 patients from prospectively collected data in a multicenter study. A minimum 24-month followup was available for 221 patients (71.8%). Patients with low back pain at baseline had worse scores on most instruments than their counterparts at baseline, 12 months postsurgery, and 24 months postsurgery. The data suggest concomitant back pain in patients undergoing rev-TKA affects their outcomes as measured by standardized instruments. Orthopaedic surgeons should counsel their patients with back pain regarding the possibility of slower or less complete recovery.

Low back pain and other musculoskeletal pain comorbidities in individuals with symptomatic osteoarthritis of the knee: Data from the osteoarthritis initiative

“…This extraordinarily high concomitant frequency is not well recognized, nor is the finding of LBP commonly documented in the clinic. Our findings provide a potential explanation for why prior studies have found that preoperative LBP is a risk factor for poor outcomes following joint replacement (6, 7). Furthermore, our findings suggest that the severity of LBP is an important correlate of increased knee symptoms.…”

“…However, this study used a version of the WOMAC applied globally without referring to the knee joint specifically (4). Longitudinal studies have demonstrated that the presence of preoperative LBP is one of the most important factors associated with poor pain outcomes after total knee arthroplasty (TKA) (6) and revision TKA (7). This small body of evidence supports a relationship between concurrent LBP and knee‐specific functional limitations, but the nature of this relationship, and other factors that may affect this relationship, remain unexplored.…”

Multiple joint involvement in total knee replacement for osteoarthritis: Effects on patient‐reported outcomes

“…Nearly one‐half of the sample reported in excess of 3 joints other than the surgical knee, and at least one‐third reported each of at least 1 upper and 1 lower extremity joint. When considering the influence of painful joints on postsurgical outcomes, the focus has been predominantly on the contralateral joint and on low back pain, and these influences have predominantly been examined in total hip replacement (32–36). Consistently painful symptoms in the contralateral joint and in the lower back have been associated with worse postsurgical pain and physical function status in these cohorts.…”

Patient-Reported Outcomes After Total Knee Replacement Vary on the Basis of Preoperative Coexisting Disease in the Lumbar Spine and Other Nonoperatively Treated Joints

“…For instance, preoperative pain in the nonoperatively treated knee was associated with poorer knee performance at three years after total knee replacement 4 . Low back pain was shown to predict poorer physical function after primary total knee replacement 5 and was associated with poorer function scores at twelve months and twenty-four months after revision total knee replacement 6 . These data warrant further investigation and discussion with regard to the importance of musculoskeletal comorbidities in patients undergoing total knee replacement.…”