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Total knee arthroplasty in patients with lumbar spinal fusion leads to significant changes in pelvic tilt and sacral slope

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

A Correction to this article was published on 08 June 2022

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Abstract

Background

The knee–hip–spine syndrome has been well elucidated in the literature in recent years. The aim of this study was to evaluate the effect of total knee arthroplasty (TKA) on spinopelvic sagittal alignment in patients with and without pre-TKA lumber spinal fusion.

Methods

This is a retrospective cohort study of 113 patients who underwent TKA for primary osteoarthritis. Patients were stratified into the following three groups: (1) patients who had pre-TKA spinal fusion (SF, n = 19), (2) patients who had no spinal fusion but experienced pre-TKA flexion contracture (FC, n = 20), and (3) patients without flexion contracture or spinal fusion before TKA (no SF/FC, n = 74). Spinopelvic sagittal alignment parameters, including pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and plumb line-sacrum distance (SVA) were measured preoperatively and 3 months postoperatively on lateral standing full-body low-dose images.

Results

TKA resulted in significant pre- to postoperative changes in pelvic tilt (average ∆ PT = − 8.6°, p = 0.018) and sacral slope (average ∆ SS = 8.6°, p = 0.037) in the spinal fusion (SF) group. Non-significant changes in spinopelvic sagittal alignment parameters (PT, SS, LL, TK, SVA) were noted postoperatively in all patients in the FC and the no SF/FC groups.

Conclusions

TKA can lead to meaningful changes in spinopelvic alignment in patients with prior lumbar fusion compared to those without spinal fusion. Patients with spinal fusion who are candidates for both hip and knee replacements should consider undergoing TKA first since changes in spinopelvic sagittal alignment can increase the risk of future complications.

Level III evidence

Retrospective Cohort Study.

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Funding

No funding was provided for this study.

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Author notes

  1. Ittai Shichman and Erel Ben-Ari should be considered equal first authors for this paper.

Authors and Affiliations

  1. NYU Langone Health, Division of Adult Reconstruction, Department of Orthopedic Surgery, Hospital of Joint Diseases, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA

    Ittai Shichman, Vivek Singh, Matthew Hepinstall & Ran Schwarzkopf

  2. Division of Orthopedic Surgery, Tel-Hashomer “Sheba” Medical Center, Sackler School of Medicine, Ramat Gan, Israel

    Erel Ben-Ari & Ethan Sissman

Authors
  1. Ittai Shichman
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  4. Vivek Singh
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  6. Ran Schwarzkopf
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Corresponding author

Correspondence to Ran Schwarzkopf.

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Conflict of interest

I.S, E.BA, E.S and V.S have nothing to disclose. M.H reports IP royalties from Corin U.S.A, Exactech Inc, Stryker, and KCI, being a paid consultant for Corin U.S.A, Exactech, Inc, Stryker, and KCI. R.S reports IP royalties from Smith & Nephew, being paid consultant for Smith & Nephew, Intelijoint, have stock options from Intelijoint, Gauss Surgical and receives research support from Smith & Nephew and Intelijoint.

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The present study was exempt from human-subjects review by our Institutional Review Board (IRB).

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The original online version of this article was revised: Article note has been included and correspond author family name should be Schwarzkopf.

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Shichman, I., Ben-Ari, E., Sissman, E. et al. Total knee arthroplasty in patients with lumbar spinal fusion leads to significant changes in pelvic tilt and sacral slope. Arch Orthop Trauma Surg 143, 2103–2110 (2023). https://doi.org/10.1007/s00402-022-04462-w

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  • DOI: https://doi.org/10.1007/s00402-022-04462-w

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