Influence of comorbid knee osteoarthritis on surgical outcome and sagittal spinopelvic/lower-extremity alignment in elderly patients with degenerative lumbar spondylolisthesis undergoing transforaminal lumbar interbody fusion

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>This retrospective study aimed to clarify the influence of comorbid severe knee osteoarthritis (KOA) on surgical outcome in terms of sagittal spinopelvic/lower-extremity alignment in elderly patients with degenerative lumbar spondylolisthesis (DLS).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>In total, 110 patients aged at least 65 years (27 men, 83 women; mean age 74.0 years) who underwent short-segment lumbar fusion were included in the present study. Using the Kellgren-Lawrence (KL) grading system, patients were categorized into those with no to mild KOA (the mild-OA group: KL grades 0–2), moderate KOA (moderate-OA group: KL grade 3), or severe KOA (severe-OA group: KL grade 4). Surgical results were assessed using the Japanese Orthopaedic Association (JOA) scoring system, and spinopelvic/lower-extremity parameters were compared among the 3 groups. Adjacent-segment disease (ASD) was assessed over a mean follow-up period of 4.7 years (range 2–8.1 years).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The study cohort was split into the mild-OA group (42 patients), the moderate-OA group (28 patients), and the severe-OA group (40 patients). The severe-OA group contained significantly more women (p = 0.037) and patients with double-level listhesis (p = 0.012) compared with the other groups. No significant differences were found in mean postoperative JOA scores or recovery rate among the 3 groups. The mean postoperative JOA subscore for restriction of activities of daily living was only significantly lower in the severe-OA group compared with the other groups (p = 0.010). The severe-OA group exhibited significantly greater pelvic incidence, pelvic tilt, and knee flexion angle (KFA), along with a smaller degree of lumbar lordosis than the mild-OA group both pre- and postoperatively (all p &lt; 0.05). Overall, the rate of radiographic ASD was observed to be higher in the severe-OA group than in the mild-OA group (p = 0.015). Patients with ASD in the severe-OA group exhibited significantly greater pelvic tilt, pre- and postoperatively, along with less lumbar lordosis, than the patients without ASD postoperatively (all p &lt; 0.05).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>A lack of lumbar lordosis caused by double-level listhesis and knee flexion contracture compensated for by far greater pelvic retroversion is experienced by elderly patients with DLS and severe KOA. Therefore, corrective lumbar surgery and knee arthroplasty may be considered to improve sagittal alignment, which may contribute to the prevention of ASD, resulting in favorable long-term surgical outcomes.</jats:p></jats:sec>

Impact of Preoperative Total Knee Arthroplasty on Radiological and Clinical Outcomes of Spinal Fusion for Concurrent Knee Osteoarthritis and Degenerative Lumbar Spinal Diseases

“…The pelvic morphology, which is influenced by sagittal malalignment, was significantly different in elderly patients with concurrent KOA and degenerative LSDs compared to patients with LSD only [ 18 ]. Increased sagittal malalignment with a lack of LL was caused by double-level listhesis (i.e., spondylolisthesis and/or retrolisthesis) and greater knee flexion [ 19 ].…”

“…Although decompression with short-segment fusion at less than three levels can yield improvement of clinical outcomes, corrective lumbar surgery alone may be insufficient for radiological outcomes because of greater pelvic retroversion (high PT) and, worse sagittal spinopelvic alignment [ 20 , 21 ]. Kohno et al reported that surgical strategies in concurrent degenerative knee and LSDs may be necessary to restore sagittal spinopelvic alignment, followed by decreased pelvic retroversion [ 18 ]. In our study, patients with preoperative TKA exhibited greater pelvic retroversion than patients with KOA, and more often required fusion surgery for correction of sagittal spinopelvic alignment.…”

Association of lower back pain(LBP) and knee osteoarthritis(KOA); a systematic review

“…A further 75 studies were excluded at the second stage screening (full text), mainly because the study aims were not related to the research question, both conditions were not explored, and non-peer reviewed publications, such as conference proceedings, comments, and research notes. Twelve studies 4,5,8,13,21,28,29,30,31,32,33,34 were therefore included into the nal analysis of the current review (Table 1).…”

Progression of pelvic retroversion is a critical factor for clinical outcome after Opening-wedge high tibial osteotomy among elderly patients

“…Poor global alignment negatively impacts the alignment of the lower extremities. Sagittal malalignment with pelvic retroversion affected knee OA via the effect on knee flexion contracture [ 10 ], which has been recognized to induce cartilage degeneration [ 16 ]. However, the effect of pelvic retroversion on the outcomes of OWHTO is still unclear.…”