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

Impact of Knee Osteoarthritis and Arthroplasty on Full-body Sagittal Alignment in Adult Spinal Deformity Patients

STUDY DESIGN

Retrospective analysis of prospectively collected data.

OBJECTIVE

This study evaluates the impact of knee osteoarthritis (OA) and knee arthroplasty on alignments and patient-reported outcomes measures (PROMS) of patients undergoing adult spinal deformity (ASD) corrective surgery.

BACKGROUND

The relationship between knee OA and spinal alignment in patients with ASD is incompletely understood. It is also unknown how patients with knee arthroplasty and ASD compare to ASD patients with native knees.

METHODS

Baseline full-body radiographs were used, and hip and knee OA were graded by two independent reviewers using the KL classification. Spinopelvic parameters and PROMs were compared across the different knee OA groups and compared between patients with knee replacement and native knees.

RESULTS

One hundred ninety-nine patients with bilateral nonsevere OA (G1), 31 patients with unilateral severe knee OA (G2), and 60 patients with bilateral severe knee OA (G3). Patients with severe knee OA presented with worse spinopelvic parameters. However, after multivariable regression analysis controlling for age, frailty, PI, T1PA, knee OA was an independent predictor of knee flexion (G1: -0.02±7.3, G2: 7.8±9.4, G3: 4.5±8.7, P <0.001), and ankle dorsiflexion (G1: 2.3±4.0, G2: 6.6±4.5, G3: 5.1±4.1, P <0.001). There was no difference in PROMs ( P >0.05). Secondary analysis included 96 patients: 48 patients (50%) with nonsevere knee OA, and 48 patients (50%) with knee replacement. There was no difference in radiographic parameters or PROMs between the groups.

CONCLUSIONS

In this study of complex ASD patients, patients with worse spinal deformities were more likely to have concomitant knee OA. Knee OA was shown to be a predictor of knee flexion and ankle dorsiflexion angles, but was not associated with worse PROMs in this study population. Patients with knee arthroplasty, however, had comparable spinal alignment and PROMs relative to those with mild OA.

Postural asymmetry in low back pain - a systematic review and meta-analysis of observational studies

PURPOSE

Systematic review and meta-analysis to examine common static postural parameters between participants with and without low back pain (LBP).

METHODS

Systematic search on the PubMed, CINAHL, Embase and SCOPUS databases using keywords 'posture' and 'low back pain'. Observational studies comparing static postural outcomes (e.g. lumbar lordosis) between participants with and without LBP were included. Two independent reviewers conducted screening, data extraction and quality assessment. Methodological quality was assessed using Joanna Briggs Institute's critical appraisal tools.

RESULTS

Studies included in review = 46 (5,097 LBP; 6,974 controls); meta-analysis = 36 (3,617 LBP; 4,323 controls). Quality of included studies was mixed. Pelvic tilt was statistically significantly higher in participants with LBP compared to controls (n = 23; 2,540 LBP; 3,090 controls; SMD:0.23, 95%CI:0.10,0.35, p < 0.01, I2=72%). Lumbar lordosis and sacral slope may be lower in participants with LBP; pelvic incidence may be higher in this group; both were not statistically significant and the between study heterogeneity was high. Thoracic kyphosis and leg length discrepancy showed no difference between groups.

CONCLUSIONS

Lumbopelvic mechanisms may be altered in people with LBP, but no firm conclusions could be made. Pelvic tilt appeared to be increased in participants with LBP. Postural variable measurement needs standardisation. Better reporting of study characteristics is warranted.

The relationship between spinopelvic alignment and knee osteoarthritis in female patients: A cross-sectional study

BackgroundThe spine, pelvis, and lower extremities move in the form of a kinematic chain.ObjectiveThis study aimed to evaluate the relationship between spinopelvic parameters and knee osteoarthritis.MethodsSixty-nine participants (50-70 years) were diagnosed with knee osteoarthritis: early-stage (n = 36) and late-stage (n = 33). Knee osteoarthritis severity was assessed using standing antero-posterior radiographs (Kellgren-Lawrence scores). A visual Analog Scale was used to evaluate knee and lumbar pain, the Western Ontario and McMaster Universities Osteoarthritis Index to evaluate knee joint function and disability, and the Oswestry Low Back Pain Disability Index to evaluate disability associated with lumbar pain. Lateral scoliosis radiographs were taken of all the study participants; pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis values were measured and recorded.ResultsMultivariate logistic regression analysis was performed to determine the independent risk factors associated with the clinical and radiological osteoarthritis severity as Body Mass Index, sagittal vertical axis and lumbopelvic mismatch increased. The sacral slope values were determined to be independently negatively correlated with the clinical osteoarthritis severity. However, no correlation was determined with the radiological severity.ConclusionIn this study, we determined that global sagittal imbalance and lumbopelvic mismatch are associated with advanced knee osteoarthritis. Although pelvic retroversion was not found to be correlated with the radiographic severity of osteoarthritis, it was found to be associated with poor functional results.

Changes in spino-pelvis-lower extremity alignment in patients with knee osteoarthritis: a prospective radiographic study

PURPOSE

Osteoarthritis (OA) is a prevalent, debilitating ailment among the elderly. Humans need a correct sagittal spino-pelvis-lower extremity alignment to stand upright. Pathology in trunk or lower extremity section might disrupt this harmony, causing compensatory alterations in other segments. The aim of the present study was to evaluate spino-pelvis-lower extremity alignment and association among the various spino-pelvic, knee, and ankle radiological angles in patients with knee osteoarthritis (OA).

MATERIALS AND METHODS

This prospective study enrolled 70 adults over 50 years of age of either sex who complained of knee pain and met the American College of Rheumatology criteria for symptomatic OA of at least one knee. The radiological assessment comprised anteroposterior and lateral lower extremity full-length scans, as well as the Kellgren-Lawrence radiographic classification of OA. We measured hip, knee, ankle, and spino-pelvic angles using Horos software. We calculated descriptive statistics and linear correlation between continuous variables.

RESULTS

There was a significant association (p < 0.05) between age and the majority of the spino-pelvic, knee, and ankle angles and between age and severity of OA. Significant variables linked with 'SFA' include HKAA (p = 0.008), mLDFA (p < 0.001), TJLA, FS-TS, Cond-Plateau, and femoral bowing (p = 0.007). We found significant associations between 'PFA' and mMPTA (p = 0.005), Cond-Plateau (p = 0.005), Tibial Bowing (p = 0.003), and 'LL' with HKAA, mLDFA, FS-TS, and Cond-Plate. SSA was significantly associated with mLDFA, mMPTA, TJLA, Cond-Plateau, and HKAA; while, FI' was significantly associated with FS-TS, femoral bowing, and tibial bowing (p < 0.001). The variables 'SS' was substantially linked with TTA (p = 0.008), TT (p = 0.004), PP (< 0.001), GP (p < 0.001), and GT (p = 0.010). 'PI' was substantially linked to TT (p = 0.001), GP (p = 0.005), and GT (p = 0.042), and 'PT' to TT (p < 0.001) and GT (p = 0.012). 'SFA' and 'PFA' only correlated with TT (p = 0.012 and 0.010). Lower limb angles were significantly associated with TT, PP, GP, GT, mLDFA, and mMPTA (p = 0.031, p = 0.026, p = 0.009, p = 0.009, TT, GP, GT, p < 0.001). GP was the sole significant association for 'TJLA' (p = 0.016). 'FS-TS' substantially correlated with PP (p = 0.015), GP (p < 0.001), and GT (p < 0.001). "Femoral Bowing" was significantly linked to PP (p = 0.017), GP (p = 0.007), and GT (p < 0.001), and "Cond-Plateau" was significantly linked to GP (p = 0.002) and GT. "Tibial Bowing" was significantly linked to TTA (p < 0.001), TAS (p = 0.003), LDTA (p = 0.002), TC (p < 0.001), GP (p = 0.007), and GT (p < 0.001). Age, gender, BMI, and the severity of knee OA significantly influenced the association among these various angles.

CONCLUSION

Osteoarthritis of the knee disrupts the harmonious alignment of the spine and pelvis with the lower limbs, resulting in compensatory changes in the ankle and spine. The severity of knee osteoarthritis and the patient's gender, age, and BMI impact compensatory adaptations.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

CTRI/2021/08/036088 [Registered on: 31/08/2021] - Trial Registered Prospectively.

Postural stability computerized evaluation in total knee arthroplasty

PURPOSE

To evaluate the balance in patients with total knee arthroplasty (TKA) and knee osteoarthrosis (KOA), measured by postural stability computerized evaluation (PSCE), and to evaluate the effect of post-TKA patients' characteristics in their performance on PSCE.

MATERIALS AND METHODS

An observational cross-sectional study was conducted in two sets of patients: (A) patients with KOA and primary TKA surgery scheduled and (B) patients who underwent primary TKA >9 months. Sociodemographic, radiographic, clinical and PSCE parameters (using the Biodex Balance System) were assessed.

RESULTS

Post-TKA patients placed more load on the replaced knee than the contralateral osteoarthritic knee (p = 0.027). They had less imbalance on the balance tests performed with the eyes open, on stable (p = 0.032), and unstable platforms (p = 0.022). These patients also showed better postural stability in monopodalic stance, both standing on the TKA (p = 0.010) and contralateral knee (p = 0.017). Age, weight, pain on the operated knee, extension deficit on the operated knee, and Berg Balance Scale scores on post-TKA patients were significantly associated with their performance on PSCE tests.

CONCLUSIONS

PSCE can be useful to quantify the balance of post-TKA and KOA patients.

How Back Pain Affects Patient Satisfaction After Primary Total Knee Arthroplasty

BACKGROUND

Although back pain (BP) has been shown to be a predictor of dissatisfaction after total knee arthroplasty (TKA) in some reports, these studies did not use a scale to quantify the degree of pain. The purpose of this study was to quantify the effect of BP intensity on patient satisfaction reported at 1 year after TKA.

METHODS

A multicenter prospective cohort was taken in which 9,057 patients undergoing primary unilateral TKA were enrolled in FORCE-TJR and demographic and clinical data were collected. Back pain (BP) intensity was assessed using the Oswestry back disability index (ODI) pain intensity questionnaire. Patients were classified into 4 categories based on the severity of BP. Patient-reported outcomes (PROs) were collected preoperatively and postoperatively after 1 year including the Knee injury and Osteoarthritis Outcome Score (KOOS) (total score, pain, Activities of Daily Living (ADL), and Quality of Life (QOL), Short-Form health survey 36-item (SF-36) Physical Component Score (PCS), and Mental Component Score (MCS)). We used a validated 5-point Likert satisfaction scale. Univariate analyses of the difference between the satisfied and dissatisfied patients' groups was performed. Multivariate logistic regression models with 95% confidence interval (CI) were used to quantify the effect of BP intensity on patient dissatisfaction at 1 year. Receiver operating characteristic (ROC) analyses were performed with measurement of area under curve (AUC).

RESULTS

At 1 year, a total of 1,657 TKA patients (18.3%) were dissatisfied. A total of 4,765 patients (52.6%) reported back pain at the time of surgery, including mild BP in 2,264 patients (24.9%), moderate BP in 1,844 patients (20.3%), and severe BP in 657 patients (7.2%). Severe back pain was significantly associated with patient dissatisfaction at 1 year after TKA (P = .0006). The multivariate regressions showed that patients who had severe BP were 1.6 times more likely to be dissatisfied when compared to patients who had no BP [odds ratio (OR) 1.63; 95% confidence interval (CI) (1.23-2.16), P = .0006]. While patients who had mild BP [OR 0.98; 95% CI (0.82-1.17), P = .87] or moderate BP [OR 0.97; 95% CI (0.80-1.18), P = .78] were not associated with an increased likelihood of dissatisfaction. Other predictive variables for dissatisfaction, include age [OR for younger patients <65 years versus older patients ≥65 years, 0.74; 95% CI (0.59-0.92)], educational level [OR for post high school versus less, 0.83; 95% CI (0.71, 0.97)], smoking [OR for nonsmoker versus current smoker, 0.63; 95% CI (0.45, 0.87)], and Charlson comorbidity index [OR for CCI ≥2 versus 0, 1.25; 95% CI (1.05, 1.49)].

CONCLUSION

Increased BP intensity was associated with increased risk of dissatisfaction 1 year after TKA. Only patients who had severe BP were 1.6 times more likely to be dissatisfied. The data presented here can help to improve shared decision-making and patient counseling before surgery. Surgeons should consider a spine evaluation in patients who have severe BP prior to TKA.

Spondylolisthesis and mismatch deformity affect outcomes after total knee arthroplasty

BACKGROUND

Little published data currently exist regarding the potential relationships between spondylolisthesis, mismatch deformity, and clinical outcomes following total knee arthroplasty (TKA). We hypothesize that preexisting spondylolisthesis will result in decreased functional outcomes after TKA.

METHODS

This retrospective cohort comparison of 933 TKAs was performed between January 2017 and 2020. TKAs were excluded if they were not performed for primary osteoarthritis (OA) or if preoperative lumbar radiographs were unavailable/inadequate to measure the degree of spondylolisthesis. Ninety-five TKAs were subsequently available for inclusion and divided into two groups: those with spondylolisthesis and those without. Within the spondylolisthesis cohort, pelvic incidence (PI) and lumbar lordosis (LL) were calculated on lateral radiographs to determine the difference (PI-LL). Radiographs with PI-LL > 10° were then categorized as having mismatch deformity (MD). The following clinical outcomes were compared between the groups: need for manipulation under anesthesia (MUA), total postoperative arc of motion (AOM) both pre-MUA or post-MUA/revision, incidence of flexion contracture, and a need for later revision.

RESULTS

Forty-nine TKAs met the spondylolisthesis criteria, while 44 did not have spondylolisthesis. There were no significant differences in gender, body mass index, preoperative knee range of motion (ROM), preoperative AOM, or opiate use between the groups. TKAs with spondylolisthesis and concomitant MD were more likely to have MUA (p = 0.016), ROM < 0-120 (p < 0.014), and a decreased AOM (p < 0.02) without interventions.

CONCLUSION

Preexisting spondylolisthesis by itself may not have adverse effect clinical results following TKA. However, spondylolisthesis increases the likelihood of developing MD. In those with both spondylolisthesis and concomitant mismatch deformities, patients had statistically and clinically significantly decreased in postoperative ROM/AOM and increased need for MUA. Surgeons should consider clinical/radiographic assessments of patients with chronic back pain who present for total joint arthroplasty.

LEVEL OF EVIDENCE

Level 3.

Effect of osteoarthritic knee flexion deformity correction by total knee arthroplasty on sagittal spinopelvic alignment in Indian population

BACKGROUND

Sagittal alignment of the spine, pelvis, and lower extremities is essential for maintaining a stable and efficient posture and ambulation. Imbalance in any element can result in compensatory changes in the other elements. Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis (OA). The correction of knee flexion deformity (KFD) by total knee arthroplasty (TKA) can lead to complementary changes in the sagittal spinopelvic parameters (SSPs).

AIM

To determine the SSP changes in patients with knee OA, with or without KFD undergoing TKA.

METHODS

The study was conducted in 32 patients who underwent TKA. A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients. Subjects were divided into two groups (Group 1 obtained > 10° corrections in KFD; group B obtained < 10° correction). The pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA) were measured.

RESULTS

The median of change in PT, PI, SS, LL, and SVA was 0.20 mm, 1.00 mm, 2.20 mm, -0.40 mm, and 6.8 mm, respectively. The difference in the change in SSPs between the two groups was statistically non-significant.

CONCLUSION

SSPs, such as PI, PT, SS, LL, and SVA, do not change significantly following TKA in end-stage knee OA despite a significant correction (> 10°) in KFD.

Compensatory biomechanics and spinal loading during dynamic maneuvers in patients with chronic low back pain

Purpose

This study explores the biomechanics underlying the sit-to-stand (STS) functional maneuver in chronic LBP patients to understand how different spinal disorders and levels of pain severity relate to unique compensatory biomechanical behaviors. This work stands to further our understanding of the relationship between spinal loading and symptoms in LBP patients.

Methods

We collected in-clinic motion data from 44 non-specific LBP (NS-LBP) and 42 spinal deformity LBP (SD-LBP) patients during routine clinical visits. An RGB-depth camera tracked 3D joint positions from the frontal view during unassisted, repeated STS maneuvers. Patient-reported outcomes (PROs) for back pain (VAS) and low back disability (ODI) were collected during the same clinical visit.

Results

Between patient groups, SD-LBP patients had 14.3% greater dynamic sagittal vertical alignment (dSVA) and 10.1% greater peak spine torque compared to NS-LBP patients (p < 0.001). SD-LBP patients also had 11.8% greater hip torque (p < 0.001) and 86.7% greater knee torque (p = 0.04) compared to NS-LBP patients. There were no significant differences between patient groups in regard to anterior or vertical torso velocities, but anterior and vertical torso velocities correlated with both VAS (r = − 0.38, p < 0.001) and ODI (r = − 0.29, p = 0.01). PROs did not correlate with other variables.

Conclusion

Patients with LBP differ in movement biomechanics during an STS transfer as severity of symptoms may relate to different compensatory strategies that affect spinal loading. Further research aims to establish relationships between movement and PROs and to inform targeted rehabilitation approaches.

Trunk control, motion and alignment after total knee arthroplasty: a systematic review and meta-analysis

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.

Clinical and radiographic parameters for patients with adult spinal deformity

Background: Improved medical care and increased life expectancy have led to a focus on the impact of adult spinal deformity (ASD) on health-related quality of life (HRQoL) in the field of the spine. Recently, there has been a paradigm shift in the evaluation and management of ASD regarding the important correlation between sagittal imbalance and clinical outcomes.Current Concepts: Loss of lumbar lordosis is recognized as a key driver of ASD followed by forward-leaning of the trunk, reducing thoracic kyphosis, pelvic retroversion, and knee flexion. Radiological assessment has been critical for evaluating ASD from the anteroposterior and lateral view of the whole spine radiograph. Important parameters include coronal, regional, global, and sagittal spinopelvic parameters. Especially, sagittal spinopelvic parameters significantly correlate with disability and HRQoL in patients with ASD, which can influence the process of decision-making with respect to the choice between conservative treatment and surgery.Discussion and Conclusion: Sagittal imbalance has been recently emphasized in patients with ASD. Therefore, the decision-making of ASD treatment should be focused on restoring harmonious alignment to prevent catastrophic complications and improvement of HRQoL.

Impact of Preoperative Total Knee Arthroplasty on Radiological and Clinical Outcomes of Spinal Fusion for Concurrent Knee Osteoarthritis and Degenerative Lumbar Spinal Diseases

Concurrent knee osteoarthritis (KOA) and degenerative lumbar spinal disease (LSD) has increased, but the total knee arthroplasty (TKA) effect on degenerative LSD remains unclear. The aim of this study was to retrospectively analyze to compare radiological and clinical outcomes between spinal fusion only and preoperative TKA with spinal fusion for the patients with concurrent KOA and degenerative LSD. A total of 72 patients with concurrent KOA and degenerative LSDs who underwent spinal fusion at less than three levels were divided in two groups: non-TKA group (n = 50) and preoperative TKA group (n = 22). Preoperative lumbar lordosis (LL) was significantly lower in the preoperative TKA group than the non-TKA group (p < 0.05). Significantly higher preoperative pelvic incidence (PI), PI/LL mismatch, and pelvic tilt (PT) occurred in preoperative TKA group than non-TKA group (all p < 0.05). There was significant improvement of postoperative Oswestry Disability Index and leg Visual Analog Scale in the preoperative TKA group (all p < 0.01). Preoperative TKA could be a benefit for in proper correction of sagittal spinopelvic alignment by spinal fusion. Therefore, preoperative TKA could be considered a preceding surgical option for patients with severe sagittal spinopelvic parameters in concurrent KOA and degenerative LSD.

Prevalence and Related Factors of Low Back Pain in the General Elderly Population: A Japanese Cross-Sectional Study Randomly Sampled from a Basic Resident Registry

Low back pain (LBP) is one of the main etiologies of disability in daily life. In the face of LBP increases in super-aged societies, there are serious concerns of escalating medical costs and deteriorations in the social economy. It is therefore important to identify the factors associated with LBP for prompt preventative and therapeutic measures. This study investigated the prevalence of LBP and the impact of subject-specific factors on LBP development in Japanese community-dwelling older adults. We established eight groups based on age (50's, 60's, 70's, and 80's) and gender after random sampling from a resident registry. A total of 411 participants (201 male and 210 female) were enrolled for a whole-spine lateral radiographic examination and dual-energy X-ray absorptiometry. All subjects were evaluated for the presence and degree of LBP. We analyzed the impact of clinical factors on LBP using multivariate analysis. Fifty-three (12.9%) participants (23 (11.4%) male and 30 (14.3%) female) were found to have LBP. The prevalence of LBP tended to increase with age, and similar results were found between genders. In univariate analysis, the subject-related factors of the sagittal vertebral axis, pelvic incidence minus lumbar lordosis (PI-LL) mismatch, and aging had significant associations with LBP. PI-LL mismatch was a significant independent factor in multivariate analysis. In conclusion, this study identified LBP prevalence and subject-specific factors on a general population basis. Multivariate analysis revealed PI-LL mismatch as an independent factor associated with LBP in the healthy community-dwelling elderly.

Improvements in lower-extremity patient-reported outcomes after lumbar interbody fusion

OBJECTIVE

Recently, new patient-reported outcome measures (PROMs) of the spine were designed to overcome the limitations of previous spinal PROMs and to consider the whole spine as a single kinetic functional unit. Owing to the significance of spine-hip-knee and global body balance, the spine and lower extremities cannot be considered separately. However, no reports have evaluated lower-extremity functional outcome using PROMs after lumbar spine surgery. The authors aimed to elucidate changes in hip and knee PROMs after lumbar interbody fusion and to evaluate the sagittal spinopelvic radiographic parameters that were most strongly correlated with lower-extremity PROMs.

METHODS

In 2018, the authors consecutively evaluated patients who underwent lumbar interbody fusion surgery with at most three levels. Preoperative and 1-year postoperative clinical and radiographic data were assessed. Spinal functional outcomes were measured with the Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and Scoliosis Research Society-22r (SRS-22r) questionnaire. Lower-extremity functional outcomes were evaluated with the Harris Hip Score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Linear regression was used to evaluate the relationship between spinal and lower-extremity PROMs and spinopelvic radiographic parameters.

RESULTS

The authors enrolled 67 patients, with a mean age of 66.4 years. The average number of surgical levels was 1.7. All assessed PROMs improved significantly after surgery (p < 0.001 for ODI, p < 0.001 for VAS, p = 0.017 for SRS-22r, p = 0.042 for HHS, and p = 0.033 for WOMAC). Spinopelvic parameters, including lumbar lordosis (LL), pelvic tilt (PT), C7 sagittal vertical axis, and sagittal radiographic parameters of hip and knee, significantly improved after surgery. On linear regression analysis, HHS and WOMAC correlated with LL and PT, respectively (β = 0.554 and p = 0.043 for correlation of HHS with LL; β = 1.573 and p = 0.021 for correlation of WOMAC with PT).

CONCLUSIONS

The current study demonstrated that lumbar fusion surgery may induce postoperative improvements in lower-extremity functional and radiological outcomes. However, among radiographic parameters, changes in LL and PT were the most strongly associated with lower-extremity PROMs.

Development International Classification of Functioning, Disability and Health Core Set for Post Total Knee Replacement Rehabilitation Program: Delphi-Based Consensus Study in Taiwan

Osteoarthritis is one of the leading causes of disability. Total knee arthroplasty (TKA) is a surgical intervention for patients with severe osteoarthritis. Post TKA rehabilitation is crucial for improving patient's quality of life. However, traditional rehabilitation has only focused on physical function; a systemic analysis of other dimensions such as social participation and environmental factors of post TKA rehabilitation is lacking. The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) to create a comprehensive rehabilitation program for patients with osteoarthritis post TKA. Before the Delphi-based consensus process, a literature review process was performed for related ICF categories selection. We used a three-round Delphi-based consensus among 20 physical therapists with orthopedic rehabilitation expertise in a university-based hospital. A five-point Likert scale was used to rate the importance of each item. The consensus of ratings was analyzed using Spearman's rho and semi-interquartile range indices. The ICF core set for post TKA rehabilitation was determined based on a high level of consensus and a mean score of ≥4.0 in the third Delphi-based consensus round. The ICF core set comprised 32 categories, with 13 regarding body function, four regarding body structures, nine regarding activities and participation, four regarding environmental factors, and two regarding personal factors. Our ICF core set for post TKA rehabilitation can provide information on effective rehabilitation strategies and goal setting for patients post TKA. However, further validation and feasibility assessments are warranted.