Effect of Correction of the Contractured Flexed Osteoarthritic Knee on the Sagittal Alignment by Total Replacement

Abstract

Study DesignA prospective analysis of an adaptive change of the spinopelvic alignment after total knee arthroplasty.PurposeTo evaluate the effect of correction of the contractured knee in flexion on the spinopelvic alignment by total knee arthroplasty.Overview of LiteratureFlexion contracture of the knee joint may affect the body posture and precipitate the symptoms in the lumbar spine, which is known as the 'knee-spine syndrome'.MethodsFifteen patients who could be followed at least over 12 months were used in this study. Neutral whole spine lateral standing radiograms taken at certain intervals were analyzed. The subjects were divided into two groups (group A, the patients who obtained over 10° correction; group B, the others). The sacral slope, the pelvic tilt and the pelvic incidence were measured preoperatively and at 12 months and thereafter postoperatively in all the patients. Also, the thoracic kyphosis, lumbar lordosis, and lumbosacral angle were measured, including the spinal sagittal balance, S1 overhang and spino-sacral angle.ResultsThe average correction of the contractured knee in flexion were 13.8° in group A and 2.7° in group B. The median of changes of the sacral slope were 4.2° in group A and -0.4° in group B. These results revealed that there was a significant increase of the sacral slope for group A (p=0.001). However, there were no significant differences between the other parameters.ConclusionsThe sacral slope appears to be affected by the change of the flexion contracture after total knee arthroplasty.

Spinal sagittal balance status affects postoperative actual falls and quality of life after decompression and fusion in-situ surgery in patients with lumbar spinal stenosis

“…[21] However, based on the whole length of lower extremities X-rays, we excluded hip/knee contractured patients and patients with other knee/hip pathologic conditions that may affect global sagittal alignment, as part of our exclusion criteria. [9] Second, we did not include patients who underwent corrective spine surgery for sagittal imbalance including various types of osteotomies and lumbar interbody fusion procedures.…”

“…[5][6][7][8] Furthermore, based on the whole length of lower extremities X-rays, patients with severe osteoarthropathic conditions that caused knee and hip joint contracture that affected whole spinal sagittal balance were also excluded from the patient pool. [9] Among the patients that met the inclusion criteria, six were lost to follow-up after 3 months or 1 year postoperatively.…”

The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images

“…Interestingly, most of the patients keep an additional pelvic retroversion for the sitting position (mean PT variation 11°) despite the standing balance has already triggered a first step of pelvic extension and the adaptation of the lower limbs (Figs. 14,15). This observation raises questions about the timing and distribution of the adaptation phenomena in the pelvic area and in the lower limbs.…”

“…This is also highly represented in the hip and/or knee patients especially in the cases needing a joint replacement. This specific combination of pathologies induces sensitive situations known as hip-spine syndromes or kneespine syndromes [11][12][13][14][15][16][17][18][19]. The hierarchy of the surgical strategies is often discussed in such patients, but the misunderstanding or underrating of the problems may lead to catastrophic situations [20].…”

Radiographic and Clinical Evidence: Osteoarthritic Knee Can Change Surgical Result for Lumbar Degenerative Disease Patient Undergone Surgery for 3-year Follow-up: A Retrospective Comparative Clinical Study

“…And also, preoperative standing teleradiographs of lower extremities were taken. Before each session of taking radiographs, the patients were instructed to stand in a comfortable position with the st-on-clavicle position [6].…”