Skip to main content
SpringerLink
Log in

Concomitant low back pain impairs outcomes after primary total knee arthroplasty in patients over 65 years: a prospective, matched cohort study

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Knee osteoarthritis and low back pain (LBP) are two conditions with relatively high prevalence in patients over 65 years. The objective was to determine the effect of symptomatic LBP on the patient-reported outcome after primary TKA.

Material and method

A cohort of 48 patients with concomitant LBP was prospectively matched 1:2 with patients without LBP for gender, age, body mass index and preoperative knee function. LBP severity was measured with the Oswestry Disability Index (ODI). Patient-reported outcomes were assessed with reduced Short-Form (SF12), Western Ontario and McMaster Universities score (WOMAC), and visual analogue scale (VAS) for satisfaction. Functional outcome was assessed with the Knee Society Scores (KSS).

Results

The mean postoperative follow-up was 3.2 years. At last follow-up, LBP cohort had significantly worse SF12, WOMAC, KSS and VAS scores than those patients without LBP. Preoperative ODI score was significantly correlated with outcomes.

Conclusion

Worse functional and patient-reported outcomes were obtained in patients over 65 years with concomitant LBP, and this was related to the intensity of preoperative LBP. Despite successful outcome in the knee, the LBP usually remains after TKA and this may impair satisfaction and patient-reported outcomes. These patients should be properly informed about their potential outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Staibano P, Winemaker M, Petruccelli D, de Beer J (2014) Total joint arthroplasty and preoperative low back pain. J Arthroplast 29:867–871

    Article  Google Scholar 

  2. Quintana JM, Arostegui I, Escobar A, Azkarate J, Goenaga JI, Lafuente I (2008) Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. Arch Intern Med 168:1576–1584

    Article  PubMed  Google Scholar 

  3. Palacios-Ceña D, Alonso-Blanco C, Hernández-Barrera V, Carrasco-Garrido P, Jiménez-García R, Fernández-de-las-Peñas C (2015) Prevalence of neck and low back pain in community-dwelling adults in Spain: an updated population-based national study (2009/10-2011/12). Eur Spine J 24:482–492

    Article  PubMed  Google Scholar 

  4. Fernández-de-Las-Peñas C, Alonso-Blanco C, Hernández-Barrera V, Palacios-Ceña D, Jiménez-García R, Carrasco-Garrido P (2013) Has the prevalence of neck pain and low back pain changed over the last 5 years? A population-based national study in Spain. Spine J 13:1069–1076

    Article  PubMed  Google Scholar 

  5. Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43

    Article  PubMed  Google Scholar 

  6. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

    Article  PubMed  Google Scholar 

  7. Escobar A, Quintana JM, Bilbao A, Azkárate J, Güenaga JI, Arenaza JC et al (2007) Effect of patient characteristics on reported outcomes after total knee replacement. Rheumatology 46:112–119

    Article  CAS  PubMed  Google Scholar 

  8. Ayers DC, Li W, Oatis C, Rosal MC, Franklin PD (2013) Patient-reported outcomes after total knee replacement vary on the basis of preoperative coexisting disease in the lumbar spine and other nonoperatively treated joints: the need for a musculoskeletal comorbidity index. J Bone Jt Surg Am 95:1833–1837

    Article  Google Scholar 

  9. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  10. Fairbank J, Pynsent PB (2000) The Oswestry Disability Index. Spine J 25:2940–2953

    Article  CAS  Google Scholar 

  11. Daltroy LH, Cats-Baril WL, Katz JN, Fossel AH, Liang MH (1996) The North American spine society lumbar spine outcome assessment instrument: reliability and validity tests. Spine 21:741–749

    Article  CAS  PubMed  Google Scholar 

  12. Ware JE Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233

    Article  PubMed  Google Scholar 

  13. Bellamy N, Buchanan W, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip and the knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  14. Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan RF, Veth RP (2001) Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplast 16:740–747

    Article  CAS  Google Scholar 

  15. Boyle JK, Anthony IC, Jones BG, Wheelwright EF, Blyth MJ (2014) Influence of low back pain on total knee arthroplasty outcome. Knee 21:410–414

    Article  CAS  PubMed  Google Scholar 

  16. Chang CB, Park KW, Kang YG, Kim TK (2014) Coexisting lumbar spondylosis in patients undergoing TKA: how common and how serious? Clin Orthop Relat Res 472:710–717

    Article  PubMed  Google Scholar 

  17. Clement ND, MacDonald D, Simpson AH, Burnett R (2013) Total knee replacement in patients with concomitant back pain results in a worse functional outcome and a lower rate of satisfaction. Bone Jt J 95:1632–1639

    Article  Google Scholar 

  18. Pivec R, Johnson AJ, Naziri Q, Issa K, Mont MA, Bonutti PM (2013) Lumbar spinal stenosis impairs function following total knee arthroplasty. J Knee Surg 26:59–64

    Article  PubMed  Google Scholar 

  19. Burnett DR, Campbell-Kyureghyan NH, Topp RV, Quesada PM (2015) Biomechanics of lower limbs during walking among candidates for total knee arthroplasty with and without low back pain. Biomed Res Int 2015:142562. doi:10.1155/2015/142562

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ali A, Sundberg M, Robertsson O, Dahlberg LE, Thorstensson CA, Redlund-Johnell I et al (2014) Dissatisfied patients after total knee arthroplasty: a registry study involving 114 patients with 8–13 years of follow-up. Acta Orthop 85:229–233

    Article  PubMed  PubMed Central  Google Scholar 

  21. Clement ND, Burnett R (2013) Patient satisfaction after total knee arthroplasty is affected by their general physical well-being. Knee Surg Sports Traumatol Arthrosc 21:2638–2646

    Article  CAS  PubMed  Google Scholar 

  22. Peltola M, Järvelin J (2014) Association between household income and the outcome of arthroplasty: a register-based study of total hip and knee replacements. Arch Orthop Trauma Surg 134:1767–1774

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain

    I. Collados-Maestre, A. Lizaur-Utrilla, D. Martinez-Mendez & L. Marco-Gomez

  2. Department of Orthopaedia and Traumatology, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain

    A. Lizaur-Utrilla & F. A. Lopez-Prats

Authors
  1. I. Collados-Maestre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Lizaur-Utrilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Martinez-Mendez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Marco-Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. A. Lopez-Prats
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Lizaur-Utrilla.

Ethics declarations

Study approved by IRB. Informed consent was required.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Collados-Maestre, I., Lizaur-Utrilla, A., Martinez-Mendez, D. et al. Concomitant low back pain impairs outcomes after primary total knee arthroplasty in patients over 65 years: a prospective, matched cohort study. Arch Orthop Trauma Surg 136, 1767–1771 (2016). https://doi.org/10.1007/s00402-016-2576-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2576-8

Keywords

Search

Navigation