Spinopelvic Alignment and Low Back Pain before and after Total Knee Arthroplasty

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Study Design

Prospective cohort study.

Purpose

This study aims to examine changes in spinopelvic alignment, sagittal global balance, and low back pain (LBP) following the removal of knee flexion contracture by total knee arthroplasty (TKA).

Overview of Literature

The limitation of the knee extension was correlated with the decrease in lumbar lordosis (LL). Currently, there are no studies evaluating the spinopelvic alignment and LBP before and after TKAs.

Methods

Sagittal spinopelvic alignment was evaluated in 110 subjects using radiographs of the whole spine. Parameters measured in this study included sagittal vertical axis (SVA), LL, sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). The distribution of sagittal plane modifier grade was evaluated according to the Scoliosis Research Society-Schwab classification of adult spinal deformity (ASD). Consequently, personal history related to LBP was obtained, and the association of pre- and postoperative LBP and spinopelvic alignment was investigated.

Results

Preoperatively, 66% of all subjects showed LBP and mostly exhibited anteriorly shifted global imbalance associated with a decrease in LL and knee flexion contractures, and the subject who had severe flexion contracture of the knee joint showed more forwardly shifted global balance with backward PT and decrease in LL. After TKAs, the knee flexion contractures were eliminated in most cases, and one-third of subjects experienced decrease in LBP. However, SVA increased more and associated with slight decrease of PT and increase of SS. No significant differences were confirmed between pre- and postoperative values of LL and PI. In addition, there were no significant differences in postoperative values of spinopelvic parameters between subjects with and without relieved LBP.

Conclusions

Although one-third of subjects experienced decrease of LBP after TKAs, the sagittal global imbalance was not restored through the removal of knee flexion contracture.

Related collections

Most cited references 25

Record: found
Abstract: found
Article: not found

Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis.

Frank J Schwab, Benjamin Blondel, Shay Bess … (2013)

Prospective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD).

0 comments Cited 241 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The impact of positive sagittal balance in adult spinal deformity.

Steven Glassman, Keith H Bridwell, John R Dimar … (2005)

This study is a retrospective review of 752 patients with adult spinal deformity enrolled in a multicenter prospective database in 2002 and 2003. Patients with positive sagittal balance (N = 352) were further evaluated regarding radiographic parameters and health status measures, including the Scoliosis Research Society patient questionnaire, MOS short form-12, and Oswestry Disability Index. To examine patients with adult deformity with positive sagittal balance to define parameters within that group that might differentially predict clinical impact. In a multicenter study of 298 adults with spinal deformity, positive sagittal balance was identified as the radiographic parameter most highly correlated with adverse health status outcomes. Radiographic evaluation was performed according to a standardized protocol for 36-inch standing radiographs. Magnitude of positive sagittal balance and regional sagittal Cobb angle measures were recorded. Statistical correlation between radiographic parameters and health status measures were performed. Potentially confounding variables were assessed. Positive sagittal balance was identified in 352 patients. The C7 plumb line deviation ranged from 1 to 271 mm. All measures of health status showed significantly poorer scores as C7 plumb line deviation increased. Patients with relative kyphosis in the lumbar region had significantly more disability than patients with normal or lordotic lumbar sagittal Cobb measures. This study shows that although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms increases in a linear fashion with progressive sagittal imbalance. The results also show that kyphosis is more favorable in the upper thoracic region but very poorly tolerated in the lumbar spine.

0 comments Cited 184 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study.

Syed Mehdian, Donald A. Deinlein, Jacob Buchowski … (2012)

Inter- and intra-rater variability study. On the basis of a Scoliosis Research Society effort, this study seeks to determine whether the new adult spinal deformity (ASD) classification system is clear and reliable. A classification of adult ASD can serve several purposes, including consistent characterization of a clinical entity, a basis for comparing different treatments, and recommended treatments. Although pediatric scoliosis classifications are well established, an ASD classification is still being developed. A previous classification developed by Schwab et al has met with clinical relevance but did not include pelvic parameters, which have shown substantial correlation with health-related quality of life measures in recent studies. Initiated by the Scoliosis Research Society Adult Deformity Committee, this study revised a previously published classification to include pelvic parameters. Modifier cutoffs were determined using health-related quality of life analysis from a multicenter database of adult deformity patients. Nine readers graded 21 premarked cases twice each, approximately 1 week apart. Inter- and intra-rater variability and agreement were determined for curve type and each modifier separately. Fleiss' kappa was used for reliability measures, with values of 0.00 to 0.20 considered slight, 0.21 to 0.40 fair, 0.41 to 0.60 moderate, 0.61 to 0.80 substantial, and 0.81 to 1.00 almost perfect agreement. Inter-rater kappa for curve type was 0.80 and 0.87 for the 2 readings, respectively, with modifier kappas of 0.75 and 0.86, 0.97 and 0.98, and 0.96 and 0.96 for pelvic incidence minus lumbar lordosis (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), respectively. By the second reading, curve type was identified by all readers consistently in 66.7%, PI-LL in 71.4%, PT in 95.2%, and SVA in 90.5% of cases. Intra-rater kappa averaged 0.94 for curve type, 0.88 for PI-LL, 0.97 for PT, and 0.97 for SVA across all readers. Data from this study show that there is excellent inter- and intra-rater reliability and inter-rater agreement for curve type and each modifier. The high degree of reliability demonstrates that applying the classification system is easy and consistent.

0 comments Cited 184 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Asian Spine J

Journal ID (iso-abbrev): Asian Spine J

Journal ID (publisher-id): ASJ

Title: Asian Spine Journal

Publisher: Korean Society of Spine Surgery

ISSN (Print): 1976-1902

ISSN (Electronic): 1976-7846

Publication date (Print): February 2021

Publication date (Electronic): 23 July 2020

Volume: 15

Issue: 1

Pages: 9-16

Affiliations

Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Kobe, Japan

Author notes

Corresponding author: Atsushi Kitagawa Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, 1070 Akebono-cho, Nishi-ku, Kobe 651-2181, Japan Tel: +81-78-927-2727, Fax: +81-78-925-9203, E-mail: a_kitagawa@ 123456hwc.or.jp

Article

Publisher ID: asj-2019-0359

DOI: 10.31616/asj.2019.0359

PMC ID: 7904480

PubMed ID: 32693445

SO-VID: 123d53f3-ddf4-4c43-91de-18dd7f8d9980

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 3 December 2019

Date revision received : 12 April 2020

Date accepted : 17 April 2020

Comments

Comment on this article

scite_

Cited by 5

See all cited by

Most referenced authors 524

See all reference authors

Spinopelvic Alignment and Low Back Pain before and after Total Knee Arthroplasty

Read this article at

Abstract

Study Design

Purpose

Overview of Literature

Methods

Results

Conclusions

Related collections

Orthopedics

Most cited references 25

Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis.

The impact of positive sagittal balance in adult spinal deformity.

Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 201

Cited by 5

Most referenced authors 524