Skip to main content

Advertisement

SpringerLink
Log in

Presence of back pain prior total knee arthroplasty and its effects on short-term patient-reported outcome measures

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Back pain may both decrease patient satisfaction after TKA and confound outcome assessment in satisfied patients. Our primary objective was to determine whether preoperative back pain is associated with differences in postoperative patient-reported outcome measures (PROMs).

Methods

We retrospectively reviewed 234 primary TKA patients who completed PROMs preoperatively and 12 weeks postoperatively, which included a back pain questionnaire, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and the Forgotten Joint Score-12 (FJS-12). Cohorts were defined based on the severity of preoperative back pain (none, mild, moderate and severe) and compared. Demographics were compared using ANOVA and Chi-square analysis. Univariate ANCOVA analysis was utilized to compare PROMs while accounting for significant demographic differences.

Results

Both preoperative KOOS JR scores (none: 47.90, mild: 47.61, moderate: 44.61 and severe: 38.70; p = 0.013) and 12-week postoperative KOOS JR scores (none: 61.24, mild: 64.94, moderate: 57.48 and severe: 57.01; p = 0.012) had a statistically significant inverse relationship with regard to the intensity of preoperative back pain. Although FJS-12 scores at the 12-week postoperative period trended lower with increasing levels of preoperative back pain (p = 0.362), it did not reach statistical significance. Patients who reported severe back pain preoperatively achieved the largest delta improvement from baseline compared to those with lesser pain intensity (p = 0.003). Patients who had a 2-grade improvement in their back pain achieved significantly higher KOOS JR scores 12 weeks postoperatively compared to patients with either 1-grade or no improvement (63.53 vs. 55.98; p = 0.042). Both preoperative (47.99 vs. 41.11; p = 0.003) and 12-week postoperative (64.06 vs. 55.73; p < 0.001) KOOS JR scores were statistically higher for those who reported mild or no back pain pre-and postoperatively than those who reported moderate or severe back pain pre-and postoperatively.

Conclusion

Knee pain and back pain both exert negative effects on outcome instruments designed to measure pain and function. Although mean improvement from pre- to postoperative KOOS JR scores for patients with severe pre-existing back pain was higher than their counterparts, this statistical difference is likely not clinically significant. This implies that all patients may experience similar benefits from TKA despite the presence or absence of back pain. Attempts to measure TKA outcomes using PROMs should seek to control for lumbago and other sources of body pain.

Level of Evidence IIIRetrospective Cohort Study

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. (2011) Relieving pain in America: A blueprint for transforming prevention, care, education and research

  2. Jüni P, Reichenbach S, Dieppe P (2006) Osteoarthritis: rational approach to treating the individual. Best Pract Res Clin Rheumatol 20:721–740

    Article  Google Scholar 

  3. Sloan M, Premkumar A, Sheth NP (2018) Projected volume of primary total joint arthroplasty in the u.s., 2014 to 2030. J Bone Jt Surg - Am 100:1455–1460. https://doi.org/10.2106/JBJS.17.01617

    Article  Google Scholar 

  4. Horváth G, Koroknai G, Ács B et al (2010) Prevalence of low back pain and lumbar spine degenerative disorders. Questionnaire survey and clinical-radiological analysis of a representative Hungarian population. Int Orthop 34:1245–1249. https://doi.org/10.1007/s00264-009-0920-0

    Article  PubMed  Google Scholar 

  5. Burnett DR, Campbell-Kyureghyan NH, Topp RV et al (2012) A retrospective study of the relationship between back pain and unilateral knee osteoarthritis in candidates for total knee arthroplasty. Orthop Nurs 31:336–343. https://doi.org/10.1097/NOR.0b013e31827425f4

    Article  PubMed  Google Scholar 

  6. Staibano P, Winemaker M, Petruccelli D, de Beer J (2014) Total Joint Arthroplasty and Preoperative Low Back Pain. J Arthroplasty 29:867–871. https://doi.org/10.1016/j.arth.2013.10.001

    Article  PubMed  Google Scholar 

  7. Clement ND, MacDonald D, Simpson AHRW, 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 Joint J 95-B:1632–1639. https://doi.org/10.1302/0301-620X.95B12.31684

  8. Choi Y-J, Ra HJ (2016) Patient Satisfaction after Total Knee Arthroplasty. Knee Surg Relat Res 28:1–15. https://doi.org/10.5792/ksrr.2016.28.1.1

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fogel GR, Esses SI (2003) Hip spine syndrome: Management of coexisting radiculopathy and arthritis of the lower extremity. Spine J 3:238–241. https://doi.org/10.1016/S1529-9430(02)00453-9

    Article  PubMed  Google Scholar 

  10. Parvizi J, Pour AE, Hillibrand A et al (2010) Back pain and total hip arthroplasty: A prospective natural history study. Clin Orthop Relat Res 468:1325–1330. https://doi.org/10.1007/s11999-010-1236-5

    Article  PubMed  PubMed Central  Google Scholar 

  11. Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “Forgotten Joint” as the Ultimate Goal in Joint Arthroplasty. Validation of a New Patient-Reported Outcome Measure. J Arthroplasty 27:. https://doi.org/10.1016/j.arth.2011.06.035

  12. Giesinger JM, Kuster MS, Behrend H, Giesinger K (2013) Association of psychological status and patient-reported physical outcome measures in joint arthroplasty: A lack of divergent validity. Health Qual Life Outcomes. https://doi.org/10.1186/1477-7525-11-64

    Article  PubMed  PubMed Central  Google Scholar 

  13. Giesinger JM, Kuster MS, Holzner B, Giesinger K (2013) Development Of A Computer-Adaptive Version Of The Forgotten Joint Score. J Arthroplasty 28:418–422. https://doi.org/10.1016/j.arth.2012.08.026

    Article  PubMed  PubMed Central  Google Scholar 

  14. Thienpont E, Opsomer G, Koninckx A, Houssiau F (2014) Joint awareness in different types of knee arthroplasty evaluated with the forgotten joint score. J Arthroplasty 29:48–51. https://doi.org/10.1016/j.arth.2013.04.024

    Article  PubMed  Google Scholar 

  15. Thompson SM, Salmon LJ, Webb JM et al (2015) Construct Validity and Test Re-Test Reliability of the Forgotten Joint Score. J Arthroplasty 30:1902–1905. https://doi.org/10.1016/j.arth.2015.05.001

    Article  PubMed  Google Scholar 

  16. Holtz N, Hamilton DF, Giesinger JM et al (2020) Minimal important differences for the WOMAC osteoarthritis index and the Forgotten Joint Score-12 in total knee arthroplasty patients. BMC Musculoskelet Disord 21:401. https://doi.org/10.1186/s12891-020-03415-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lyman S, Lee YY, Franklin PD et al (2016) Validation of the KOOS, JR: A Short-form Knee Arthroplasty Outcomes Survey. Clin Orthop Relat Res 474:1461–1471. https://doi.org/10.1007/s11999-016-4719-1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hung M, Bounsanga J, Voss MW, Saltzman CL (2018) Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction and knee injury and osteoarthritis ou. World J Orthop 9:41–49. https://doi.org/10.5312/wjo.v9.i3.41

    Article  PubMed  PubMed Central  Google Scholar 

  19. Long WJ, Bryce CD, Hollenbeak CS, et al (2014) Total knee replacement in young, active patients: Long-term follow-up and functional outcome: A Concise Follow-up of a Previous Report. J Bone Jt Surg - Am Vol 96:e159(1). https://doi.org/10.2106/JBJS.M.01259

  20. Kim TK, Chang CB, Kang YG et al (2009) Causes and Predictors of Patient’s Dissatisfaction After Uncomplicated Total Knee Arthroplasty. J Arthroplasty 24:263–271. https://doi.org/10.1016/j.arth.2007.11.005

    Article  PubMed  Google Scholar 

  21. Wang WJ, Liu F, Zhu YW et al (2016) Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: A radiographic study. Bone Jt Res 5:198–205. https://doi.org/10.1302/2046-3758.55.2000538

    Article  CAS  Google Scholar 

  22. Suri P, Morgenroth DC, Kwoh CK et al (2010) Low back pain and other musculoskeletal pain comorbidities in individuals with symptomatic osteoarthritis of the knee: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken) 62:1715–1723. https://doi.org/10.1002/acr.20324

    Article  Google Scholar 

  23. Gunaratne R, Pratt DN, Banda J et al (2017) Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. J Arthroplasty 32:3854–3860

    Article  Google Scholar 

  24. 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. https://doi.org/10.1007/s11999-013-3298-7

    Article  PubMed  Google Scholar 

  25. Escobar A, Quintana JM, Bilbao A et al (2007) Effect of patient characteristics on reported outcomes after total knee replacement. Rheumatology 46:112–119. https://doi.org/10.1093/rheumatology/kel184

    Article  CAS  PubMed  Google Scholar 

  26. Brady SRE, Hussain SM, Brown WJ et al (2016) Relationships between weight, physical activity and back pain in young adult women. Med (United States). https://doi.org/10.1097/MD.0000000000003368

    Article  PubMed  PubMed Central  Google Scholar 

  27. Konstantinou K, Dunn KM, Ogollah R et al (2015) Characteristics of patients with low back and leg pain seeking treatment in primary care: Baseline results from the ATLAS cohort study Epidemiology of musculoskeletal disorders. BMC Musculoskelet Disord. https://doi.org/10.1186/s12891-015-0787-8

    Article  PubMed  PubMed Central  Google Scholar 

  28. Vigdorchik JM, Sharma AK, Feder OI et al (2020) Stiffness After Total Knee Arthroplasty: Is It a Result of Spinal Deformity? J Arthroplasty 35:S330–S335. https://doi.org/10.1016/j.arth.2020.02.031

    Article  PubMed  Google Scholar 

  29. Bjorgul K, Novicoff WM, Saleh KJ (2010) Evaluating comorbidities in total hip and knee arthroplasty: available instruments. J Orthop Traumatol 11:203–209

    Article  Google Scholar 

  30. Greene ME, Rolfson O, Gordon M et al (2015) Standard Comorbidity Measures Do Not Predict Patient-reported Outcomes 1 Year After Total Hip Arthroplasty. Clin Orthop Relat Res 473:3370–3379. https://doi.org/10.1007/s11999-015-4195-z

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hilton ME, Gioe T, Noorbaloochi S, Singh JA (2016) Increasing comorbidity is associated with worsening physical function and pain after primary total knee arthroplasty. BMC Musculoskelet Disord 17:421. https://doi.org/10.1186/s12891-016-1261-y

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Predicting the Outcome of Total Knee Arthroplasty. J Bone Jt Surg 86:2179–2186. https://doi.org/10.2106/00004623-200410000-00008

    Article  Google Scholar 

  33. Dunbar M, Robertsson O, Ryd L (2004) What’s all that noise? The effect of co-morbidity on health outcome questionnaire results after knee arthroplasty. Acta Orthop Scand 75:119–126. https://doi.org/10.1080/00016470412331294355

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA

    Vivek Singh, Stephen Zak, Joseph X. Robin, David N. Kugelman, Matthew S. Hepinstall, William J. Long & Ran Schwarzkopf

Authors
  1. Vivek Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen Zak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph X. Robin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David N. Kugelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew S. Hepinstall
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William J. Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ran Schwarzkopf
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Singh, Mr. Zak, Dr. Robin and Dr. Kugelman have nothing to disclose. Dr. Hepinstall reports being a paid consultant for Corin U.S.A, Exactech Inc, Stryker and KCI as well as receiving research support from Cymedica, Flexion Therapeutics and Stryker outside the submitted work. Dr. Long reports being a paid consultant/speaker for Convatec, DePuy, A Johnson & Johnson Company, Pacira, Think Surgical and TJA as well as receiving IP royalties from Ortho Development, outside the submitted work. Dr. Schwarzkopf reports being a paid consultant for Smith & Nephew and Intellijoint and has stock options in Gauss Surgical, outside the submitted work.

Corresponding author

Correspondence to Ran Schwarzkopf.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest pertinent to this study.

Ethics Approval

The records and existing data were de-identified and a part of our institutional quality improvement program; therefore, the present study was exempt from human-subjects review by our Institutional Review Board (IRB).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, V., Zak, S., Robin, J.X. et al. Presence of back pain prior total knee arthroplasty and its effects on short-term patient-reported outcome measures. Eur J Orthop Surg Traumatol 32, 541–549 (2022). https://doi.org/10.1007/s00590-021-03010-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-021-03010-3

Keywords

Search

Navigation