Knee-Spine Syndrome: Management Dilemma When Knee Osteoarthritis Coexists With Spine Degeneration

Abstract

The elderly present with progressive degenerative osteoarthritis of the knee and lumbar spine degeneration (LSD). The coexistent conditions when presented concurrently become challenging for the clinicians and surgeons, as well as determining the predominant source of the underlying pain generation factor. The concurrent presentation of a significant knee and low back pain poses challenges in decision-making for treatment with management being normally individualized. The review narrates the different concepts used for the assessment of knee-spine syndrome. The prime factor for the pain needs to be ascertained by evaluating the deformity of the lumbar spine and the knees to address the causative factor appropriately. A thorough history, detailed examination, and supplemental diagnostic testing will differentiate the clinical entities and guide the treatment. However, a misdiagnosis may need a secondary site surgery and further treatment to alleviate the pain. Clinicians have been challenged while differentiating between the knee and spine pathology to target prime pain generator factors for adequate pain relief, improved functional outcomes, and substantial patient satisfaction. We present our strategy for the management of knee-spine syndrome. The protocols utilized to manage the clinical scenario have been reviewed and discussed. Clinical pearls to identify and treat the symptomatic concurrent knee-spine degeneration are presented. There is still a lack of consensus on the concurrent knee-spine degenerative pathology and its management strategy. The dilemma persists, and a case-based approach needs to be adopted by surgeons.

Association Between Osteoarthritis Burden and Intervertebral Disk Degeneration in Patients Undergoing Lumbar Spine Surgery for Degenerative Lumbar Spondylolisthesis

“…23 The concurrent presence of OA with spinal pathologies is a recognized clinical challenge. 4,7 Although similar molecular pathways have been documented 24,25 , our research is the first to uniquely demonstrate that this association exists independent of age, and thus underlying factors are more relevant in this co-occurrence than previously understood.…”

“…4,5 Moreover, knee OA has been linked with spine diseases under the term "knee-spine syndrome," and these three conditions combined, resulting in "knee-hip-spine syndrome," have been proposed more recently. 6,7 Both phenomena, OA of the lower extremities and spinal degeneration, are age-related changes that share other risk factors such as body mass index (BMI) and sex. [8][9][10] Although they share common demographic risk factors, a study by Prather et al 11 found a higher-than-expected co-occurrence of hip OA and spinal degeneration in patients undergoing total hip replacement according to billing codes.…”

“…The occurrence of OA of the hip and degenerative spinal conditions was initially described by Offierski and MacNab 3 in 1983 as the “hip-spine syndrome.” This combination gives rise to additional challenges in the diagnosis and treatment of these patients 4,5 . Moreover, knee OA has been linked with spine diseases under the term “knee-spine syndrome,” and these three conditions combined, resulting in “knee-hip-spine syndrome,” have been proposed more recently 6,7 …”

Correlations between Sagittal Parameters and Functional Scores in 65-Year-Old Osteoporotic Females with Vertebral Body Fracture under Low-Energy Mechanism

“…Maintaining such postural compensations demands higher energy expenditure than maintaining a normal posture. Over the long term, this may contribute to chronic back pain, an elevated risk of falls, or secondary osteoarthritis of the knees [20].…”

Improvement in Pre-Operative Abnormal Posture After Total Knee Arthroplasty for Knee-Hip-Spine Syndrome

“…Lower extremity malalignment syndrome, or knee-hip-spine syndrome (KHSS), is a prevalent musculoskeletal ailment that affects a large number of people [1]. It is typified by aberrant lower extremity alignment, which results in a variety of postural abnormalities, such as discomfort in the knees, hips, and spine [2]. Affected people may find it difficult to carry out everyday tasks and maintain an active lifestyle as a result of these symptoms, which can have a significant negative influence on their quality of life.…”