Severity and location of lumbar spine stenosis affects the outcome of total knee arthroplasty

Abstract

Background Recent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility before and after TKA. Methods This retrospective case series assessed all TKAs performed at our institution for primary osteoarthritis from 2017–2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery was necessary for inclusion. Stenosis severity was demonstrated by (1) anterior–posterior (AP) diameter of the thecal sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. Results Patients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1–2, L2–3, L3–4, and L4–5, there was a significant reduction in preoperative-AOM (p < 0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p < 0.001). The same was noted with respect to increased morphological grade (p < 0.001), with a 5 degree decrease for patients’ most stenotic level (p < 0.001). Conclusion Severe LSS, which is readily demonstrated by a reduction in the AP diameter of the thecal sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of evidence: Level 4

Persistent pain following total knee arthroplasty: The role of underlying diseases

“…also found that by reducing the internal diameter of the spine, especially in lumbar levels 1–4, and creating pressure on the spinal cord, the range of motion of the lower limbs significantly decreased, and the pain and spasm of the lower limbs, including in the knees, were increased. [ 27 ] However, no significant relationship between spine diseases and pain was found in the patients of the present study. To explain the disparity between the results of the studies mentioned and those of the current study, it is possible to point to the type of previous studies, the lack of investigation into the age groups of patients and their gender in the current study, and the specific relationship between spinal disease (spondylolysis myelopathy) and pain in the previous studies.…”

Persistent Pain following Total Knee Arthroplasty; The Role of Underlying Diseases

“…The authors have pointed out that undiagnosed diseases related to the spinal cord and spine may be the reason for the continuation or exacerbation of pain after TKA [23]. Shepard and colleagues also found that by reducing the internal diameter of the spine, especially in lumbar levels 1 to 4, and creating pressure on the spinal cord, the range of motion of the lower limbs signi cantly decreased, and the pain and spasm of the lower limbs, including in the knees, is increased [24]. However, no signi cant relationship between spine diseases and pain was found in the patients of the present study.…”

Spondylolisthesis and Mismatch Deformity Affect Outcomes after Total Knee Arthroplasty

“…All spinopelvic parameters were obtained in accordance to institutional protocol [29]. There were no statistical differences in materials used or post-operative radiographic parameters in accordance with prior studies from our group [29,30].…”

“…Studies have shown that spinal sagittal mismatch deformity and lumbar stenosis negatively affect TKA, but there is little evidence regarding spondylolisthesis affecting TKA outcomes [29][30]. Thus, we performed a retrospective review to analyze the relationship of predisposing spondylolisthesis and TKA outcomes among patients receiving TKAs at our institution.…”