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

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript



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).


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.


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.


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

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Authors and Affiliations



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.

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Correspondence to Ran Schwarzkopf.

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

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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).

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

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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).

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