gms | German Medical Science

Background: Information regarding the percentage of patients with bilateral knee osteoarthritis undergoing Total knee replacement (TKR) procedure have coexistent lumbar spondylosis symptoms and the effect of TKR on the lumbar spine symptoms would be extremely important for pre operative patient consultation and management.

Aim: To study the percentage of bilateral knee osteoarthritis patients undergoing TKR have a lumbar spine problem and whether the TKR procedure helps in relieving the lumbar spine pain.

Material and Methods: We prospectively studied 200 patients (164 females and 36 males) undergoing primary TKR. Follow up was at 4 weeks, 3 months, 6 months, 12 months and 2 years after TKR surgery. The improvement in lumbar spine symptoms was assessed with Oswestry Disability Index (ODI).

Results: All the 200 patients undergoing bilateral TKR had radiographic lumbar spine degenerative pathology. 60 percent of the patients had moderate/severe clinical symptoms of lumbar spondylosis and degenerative lumbar spine disease. 54 % (n=108) of them had degenerative lumbar spondylosis and lumbar canal stenosis and 6 percent (n=12) of them had degenerative spondylolisthesis. 90 percent of the 120 patients (108) who had lumbar spine problem reported improvement in their lumbar spine symptoms. The ODI score improved from pre operative 42.5 % ± 4.1 SD to post operative 15.6 % ± 2.3SD, p value<0.001. Out of the 12 patients who did not improve, 10 patients underwent percutaneous procedure for their lumbar spine pathology with good results, one patient underwent surgery and one declined any intervention.

Conclusion: Significant no of patients undergoing bilateral TKR have associated symptomatic lumbar spine problem (60%) and majority of them (90%) experience good relief of their spinal symptoms after the TKR surgery. Hence in patients having both knee osteoarthritis and lumbar spine problem it is advantageous to address the knee osteoarthritis first followed by if required spine problem.