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Hambrecht J, Köhli P, Chiapparelli E, Zhu J, Guven AE, Evangelisti G, Burkhard MD, Tsuchiya K, Duculan R, Altorfer FCS, Shue J, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. The spinopelvic alignment in patients with prior knee or hip arthroplasty undergoing elective lumbar surgery. Spine J 2024:S1529-9430(24)00986-0. [PMID: 39278271 DOI: 10.1016/j.spinee.2024.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/18/2024] [Accepted: 08/24/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND CONTEXT Concurrent degeneration of the lumbar spine, hip, and knee can cause significant disability and lower quality of life. Osteoarthritis in the lower extremities can lead to movement limitations, possibly requiring total knee arthroplasty (TKA) or total hip arthroplasty (THA). These procedures often impact spinal posture, causing alterations in spinopelvic alignment and lumbar spine degeneration. It is unclear if patients with a history of prior total joint arthroplasty (TJA) have different spinopelvic alignment compared to patients without. PURPOSE To assess the relationship between a history of previous THA or TKA, as well as combined THA and TKA, and the spinopelvic alignment in patients undergoing elective lumbar surgery for degenerative conditions. STUDY DESIGN A retrospective analysis was conducted on patients who underwent lumbar surgery for degenerative conditions. The patients were stratified based on a history of TKA, THA, or both TKA and THA. PATIENT SAMPLE A total of 632 patients (63% female) with an average age of 64±11 years and an average BMI of 30±6 kg/m2 were included. OUTCOME MEASURES Patients were stratified based on a history of THA, TKA, or combined THA and TKA. Spinopelvic parameters (lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were assessed. The relationship between spinopelvic alignment and prior TKA, THA or TKA and THA was analyzed METHODS: The data was tested for normal distribution using the Shapiro-Wilk test. We analyzed the relationship between the spinopelvic parameters and the different arthroplasty groups. Differences in scores between groups were examined using ANOVA. Tukey's Honestly Significant Difference test was used for pairwise comparison for significant ANOVA test results. Multivariable linear regression was applied, adjusted for age, sex and BMI. RESULTS A total of 632 patients (63% female) were included in the study. Of these patients, 74 (12%) had a history of isolated TKA, 40 (6%) had prior isolated THA, and 15 (2%) had TKA and THA prior to lumbar surgery. Patients with prior arthroplasty were predominantly female (59%) and significantly older (68±7 years vs. 63±12 years, p<.001) with a significantly higher BMI (31±6 kg/m2 vs. 29±6 kg/m2, p<.001). The LL was significantly lower (45.0°±13 vs. 50.9°±14 p=.011) in the arthroplasty group compared to the nonarthroplasty group. A history of isolated TKA was significantly associated with lower LL (Est=-3.8, 95% CI -7.3 to -0.3, p=.031) and SS (Est=-2.6, 95% CI -5.0 to -0.2, p=.012) compared to patients without TJA. Prior combined THA and TKA was found to be significantly associated with a higher PT compared to the nonarthroplasty group (Est=5.1, 95% CI 0.4-9.8, p=.034). CONCLUSION The spinopelvic alignment differs between patients with and without prior TJA who undergo elective lumbar surgery. The study shows that a history of TKA is significantly associated with a lower LL and SS. The combination of THA and TKA was associated with a significantly higher PT. These findings highlight the complex relationship between the hip, spine, and knee. Moreover, the results could aid in enhancing preoperative planning of lumbar surgery in patients with known TJA.
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Affiliation(s)
- Jan Hambrecht
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Paul Köhli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Gisberto Evangelisti
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Marco D Burkhard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Koki Tsuchiya
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Roland Duculan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Franziska C S Altorfer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Carol A Mancuso
- Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
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Ogawa H, Nakamura Y, Akiyama H. Restricted kinematically aligned total knee arthroplasty with an anatomically designed implant can restore constitutional coronal lower limb alignment. Knee Surg Sports Traumatol Arthrosc 2024; 32:47-53. [PMID: 38226728 DOI: 10.1002/ksa.12019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Restricted kinematically aligned total knee arthroplasty (rKA-TKA) may not restore the constitutional varus alignment in most patients with knee osteoarthritis. This study aimed to investigate (1) the extent to which constitutional lower limb alignment can be restored by rKA-TKA using an anatomically designed implant and (2) which lower limb alignment parameters are associated with patient-reported outcome measures (PROMs). METHODS This study included 60 patients who underwent rKA-TKA using an anatomically designed implant. Radiographic alignment parameters, including mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), coronal hip-knee-ankle angle (HKA), coronal joint line obliquity (JLO), posterior tibial slope (PTS), single-leg standing knee flexion angle (KFA), sagittal JLO, and arithmetic HKA (aHKA), were evaluated preoperatively and postoperatively. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used for clinical evaluation. RESULTS The mLDFA, MPTA, and aHKA showed no significant differences before and after surgery. Coronal HKA and PTS have significantly changed from 8.1 ± 8.7° and 9.9 ± 8.6° preoperatively to 3.5 ± 3.1° and 2.5 ± 2.0° postoperatively, respectively (p < 0.001 for each comparison). The postoperative WOMAC total score was significantly correlated with the KFA (r = 0.4063, p = 0.0034) and sagittal JLO (r = -0.3435, p = 0.0157). Postoperative KFA is a causal factor for the increased postoperative WOMAC total score (r = 1.416, 95% confidence interval: 0.491-2.342, p = 0.003). CONCLUSION rKA-TKA using an anatomically designed implant can restore constitutional coronal lower limb alignment, while postoperative KFA and sagittal JLO were associated with poor PROMs. Care should be taken for the postoperative KFA because it is a risk factor for poor PROMs. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yutaka Nakamura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Shichman I, Ben-Ari E, Sissman E, Singh V, Hepinstall M, Schwarzkopf R. Total knee arthroplasty in patients with lumbar spinal fusion leads to significant changes in pelvic tilt and sacral slope. Arch Orthop Trauma Surg 2023; 143:2103-2110. [PMID: 35536355 DOI: 10.1007/s00402-022-04462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
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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Affiliation(s)
- Ittai Shichman
- 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
| | - Erel Ben-Ari
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Ethan Sissman
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Vivek Singh
- 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
| | - Matthew Hepinstall
- 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
| | - Ran Schwarzkopf
- 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.
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Van Criekinge T, Winnock de Grave P, Luyckx T, Claeys K. Trunk control, motion and alignment after total knee arthroplasty: a systematic review and meta-analysis. Gait Posture 2022; 94:173-188. [PMID: 35339965 DOI: 10.1016/j.gaitpost.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trunk control improves mobility, balance and quality of life early after total knee arthroplasty (TKA) and is therefore considered an important parameter during the recovery process. However, little is known about trunk control, motion and alignment after TKA. Increasing our understanding aids in optimizing treatment strategies to enhance functional mobility after TKA. RESEARCH QUESTION Does trunk control, motion and alignment return to normal after TKA and is this related to functional mobility? METHODS Five scientific databases were searched until July 2021. Eligibility criteria consisted of outcomes assessing trunk control and alignment in a population of adults undergoing TKA. Two reviewers independently screened studies and risk of bias was assessed by Mixed Methods Appraisal Tool (MMAT). Meta-analysis was performed for subgroups gait and alignment. RESULTS Of the 362 studies retrieved, 24 were included. Study designs were cohorts with mixed methods (pre-post treatment, case-control and case-case) and three randomized controlled trials. The mean MMAT score was 75%, corresponding to low bias. In total 1178 patients and 197 controls were included. Results showed that pre-operative trunk motion was characterized by increased amplitudes in all three planes and altered alignment which did not all return to normal after TKA. Frontal plane motion and alignment recovered faster than the sagittal and transversal plane. Although pelvic tilt improved after surgery, sagittal imbalance (anteriorly shifted trunk position) was still present. SIGNIFICANCE Recovery of trunk motion after TKA is time-, speed- and technique-dependent. The observed differences in trunk motion with the healthy controls persisted after TKA. This indicates that incorporating a full biomechanical chain approach, including trunk motion and gait-retraining exercises with a strong focus on postural alignment could improve functional mobility after TKA. Limited studies are available assessing trunk control and trunk motion during functional tasks besides walking which warrant further investigation.
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Affiliation(s)
- Tamaya Van Criekinge
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Bruges, Belgium.
| | | | - Thomas Luyckx
- Dept. Orthopedic Surgery, AZ Delta Roeselare, Roeselare, Belgium
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Bruges, Belgium
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Okamoto Y, Wakama H, Okayoshi T, Matsuyama J, Otsuki S, Neo M. Spinopelvic mismatch is associated with patient-reported outcome measures after total knee arthroplasty at a mean follow-up of 15 years. Knee 2022; 34:156-166. [PMID: 34923348 DOI: 10.1016/j.knee.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/02/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely performed; yet, up to 25% of patients are dissatisfied with outcomes. Our aim was to evaluate the association between a spinopelvic mismatch and patient-reported outcomes after TKA. METHODS This was a retrospective study of 101 TKAs performed for osteoarthritis, at a mean 14.6 (range, 10.0-18.0) years post-surgery. Postoperative knee joint perception was evaluated as 'artificial', with or without restrictions, or 'natural'. Age, sex and the spinopelvic mismatch were compared between the 'artificial' (n = 54) and 'natural' (n = 47) perception groups. Multiple logistic regression analysis was used to identify predictive factors of an artificial perception, with a receiver operating characteristic curve to identify cut-off values for significant factors. RESULTS A spinopelvic mismatch, defined as a pelvic incidence minus lumbar lordosis (PI-LL) ≥ 10°, was associated with an artificial perception (odds ratio, 1.57; 95% confidence interval, 1.29-3.22; P = 0.023). An artificial joint perception was related to lower Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR, P = 0.021) and EuroQol 5-Dimension (EQ-5D, P = 0.025) scores. The cut-off PI-LL of 11° differentiated the groups with a sensitivity of 87.0% and specificity of 91.9%. Postoperative KOOS-JR (P < 0.001), EQ-5D (P = 0.014), satisfaction (P = 0.015), knee extension angle (P = 0.024), and perception (P = 0.032) differed between the groups when the PI-LL threshold was set at 10°. CONCLUSION A spinopelvic mismatch (PI-LL ≥ 10°) is associated with a risk of artificial perception of function after TKA. Measurement of the PI-LL could assist patients and surgeons to predict TKA outcomes.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
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