Joint Reconstruction Center, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
Clin Orthop Relat Res. 2014 Feb;472(2):710-7. doi: 10.1007/s11999-013-3298-7. Epub 2013 Sep 25.
Information on the coexistence of lumbar spondylosis and its influence on overall levels of pain and function in patients with advanced knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA) would be valuable for patient consultation and management.
QUESTIONS/PURPOSES: The purposes of this study were to document the prevalence and severity of coexisting lumbar spondylosis in patients with advanced knee OA undergoing TKA and to determine whether the coexisting lumbar spondylosis at the time of TKA adversely affects clinical scores in affected patients before and 2 years after TKA.
Radiographic lumbar spine degeneration and lumbar spine symptoms including lower back pain, radiating pain at rest, and radiating pain with activity were assessed in 225 patients undergoing TKA. In addition, the WOMAC score and the SF-36 scores were evaluated before and 2 years after TKA. Potential associations of radiographic lumbar spine degeneration and lumbar spine symptom severities with pre- and postoperative WOMAC subscales and SF-36 scores were examined.
All 225 patients had radiographic degeneration of the lumbar spine, and the large majority (89% [200 of 225]) had either moderate or severe spondylosis (72% and 17%, respectively). A total of 114 patients (51%) had at least one moderate or severe lumbar spine symptom. No association was found between radiographic severity of lumbar spine degeneration and pre- and postoperative clinical scores. In terms of lumbar spine symptoms, more severe symptoms were likely to adversely affect the preoperative WOMAC and SF-36 physical component summary (PCS) scores, but most of these adverse effects improved by 2 years after TKA with the exception of the association between severe radiating pain during activity and a poorer postoperative SF-36 PCS score (regression coefficient = -5.41, p = 0.015).
Radiographic lumbar spine degeneration and lumbar spine symptoms are common among patients with advanced knee OA undergoing TKA. Severe lumbar spine symptoms (visual analog scale score of ≥ 7) were likely to adversely affect the preoperative clinical scores of patients undergoing TKA; however, most of the adverse effects were not found 2 years after TKA. Nevertheless, because preexisting severe radiating pain during activity may be a source of a poorer outcome after TKA, careful patient consultation regarding this potential poorer prognosis after TKA needs to be provided to the patient with this symptom.
了解腰椎颈椎病与晚期膝关节骨关节炎（OA）患者全膝关节置换术（TKA）后整体疼痛和功能水平之间的关系，对于患者咨询和管理具有重要价值。
问题/目的：本研究旨在记录接受 TKA 的晚期膝关节炎患者中并存的腰椎颈椎病的患病率和严重程度，并确定 TKA 时并存的腰椎颈椎病是否会对 TKA 前和 TKA 后 2 年时受影响患者的临床评分产生不利影响。
对 225 例接受 TKA 的患者进行放射学腰椎退行性变和腰椎症状（包括下腰痛、静息时放射痛和活动时放射痛）评估。此外，还在 TKA 前和 TKA 后 2 年评估了 WOMAC 评分和 SF-36 评分。检查放射学腰椎退行性变和腰椎症状严重程度与 TKA 前后 WOMAC 亚量表和 SF-36 评分的潜在关联。
所有 225 例患者的腰椎均有放射学退变，绝大多数（89%[225 例中的 200 例]）存在中度或重度颈椎病（分别为 72%和 17%）。共有 114 例（51%）患者至少有一种中度或重度腰椎症状。放射学腰椎退行性变的严重程度与 TKA 前后的临床评分之间没有关联。就腰椎症状而言，更严重的症状可能会对 TKA 前的 WOMAC 和 SF-36 躯体成分综合评分产生不利影响，但这些不利影响中的大多数在 TKA 后 2 年得到改善，除了活动时严重放射痛与术后 SF-36 躯体成分综合评分较差之间的关联（回归系数=-5.41，p=0.015）。
放射学腰椎退行性变和腰椎症状在接受 TKA 的晚期膝关节炎患者中很常见。严重的腰椎症状（视觉模拟评分≥7）可能会对接受 TKA 的患者的术前临床评分产生不利影响；然而，在 TKA 后 2 年时并未发现这些不利影响。尽管如此，因为活动时的严重放射痛可能是 TKA 后结局较差的原因，对于有这种症状的患者，需要仔细向其咨询这种潜在较差预后的问题。
