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

Abstract

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.

Prevalence of multimorbid degenerative lumbar spinal stenosis with knee or hip osteoarthritis: a systematic review and meta-analysis

“…The multimorbidity prevalence pattern may also differ in samples where knee or hip OA is the index condition. Only two studies included data allowing for prevalence estimates of knee OA and comorbid LSS [ 38 , 42 ] and we found no studies of hip OA and comorbid LSS. We were also unable to explore differences in prevalence estimates for varying clinical presentations of LSS, such as neurogenic claudication, radicular pain, or radiculopathy [ 31 ] as well as the impact differing levels of participant or clinical characteristics such as disease severity or stage, as this information was not consistently reported in the included studies.…”

“…Two studies estimating the prevalence of index knee OA with comorbid LSS were included [ 38 , 42 ] (Table 1 ). One study each was from Korea [ 38 ] and India [ 42 ] with one study using a cross-sectional design [ 38 ] and one a cohort [ 42 ]. One study used a sample from a secondary care [ 42 ] and the other from a national health insurance database [ 38 ].…”

“…One study each was from Korea [ 38 ] and India [ 42 ] with one study using a cross-sectional design [ 38 ] and one a cohort [ 42 ]. One study used a sample from a secondary care [ 42 ] and the other from a national health insurance database [ 38 ]. Sample sizes were 200 and 2,857,999, the proportion of females was 62 and 82%, respectively and the mean ages were 64 and 66 years.…”

“…It was not possible to pool prevalence estimates of knee OA with comorbid LSS. The single study ( n =200) using a combined definition of knee OA and a combined definition of LSS reported a prevalence of 54% (95% CI 47-61%) [ 42 ] whereas the other ( n =2,857,999) using a combined definition of knee OA and a clinical definition of LSS reported a prevalence of 17% (95% CI 17-17%) [ 38 ].…”

“…In one study providing data on the prevalence of comorbid LSS in a knee OA sample primarily from secondary care settings, the prevalence of clinically-defined LSS [17% (95% CI 17-17%)] [ 38 ] was lower than that observed in a recent meta-analysis of prevalence estimates of clinically-defined LSS in secondary care samples [29% (95% CI 22-36%)] and mixed primary and secondary care samples [39% (95% 38-39%)] [ 9 ]. The second study reporting the prevalence of comorbid LSS in a secondary care knee OA sample [54% (95% CI 47-61%)] [ 42 ] was much higher than reported in the LSS prevalence review.…”