Department of Orthopaedic Surgery, Stanford University, Redwood City, California; Department of Bioengineering, Stanford University, Redwood City, California.
Department of Orthopaedic Surgery, Duke University, Chapel Hill, North Carolina.
J Arthroplasty. 2020 Aug;35(8):2039-2043. doi: 10.1016/j.arth.2020.03.018. Epub 2020 Mar 14.
Total knee arthroplasty (TKA) and lumbar spine surgery have been reported to affect the outcomes of each other. There is insufficient evidence to guide the choice of treatment order for patients with both disorders that are equally symptomatic.
Five clinical scenarios of concurrent, advanced, degenerative knee and lumbar spinal disorders were designed to survey surgeons' choices of treatment order and rationale. The spinal disorder was consistently degenerative lumbar spinal stenosis, but the knee conditions varied to include (1) osteoarthritis (OA) with varus deformity, (2) OA with valgus deformity, (3) rheumatoid arthritis with a severe flexion contracture, (4) OA without deformity, and (5) bilateral OA with windswept deformities. The survey was distributed to selected clinical members of the Knee Society and Scoliosis Research Society in North America. The surgeons' choices were compared among the 5 scenarios, and their comments were analyzed using text-mining.
Responses were received from 42 of 74 (57%) knee arthroplasty surgeons and 55 of 100 (55%) spine surgeons. The percentages of knee arthroplasty surgeons recommending "TKA first" differed significantly among scenarios: 29%, 79%, 55%, 7%, and 81% for scenarios 1 through 5, respectively (P < .001). A similar pattern was noted for the spine surgeons.
For patients with concurrent degenerative knee and lumbar spinal disorders, the severity and type of knee deformity influenced the preference of treatment order in both specialties. Severe valgus deformity and windswept deformities of the knee would drive the decision toward "TKA first."
全膝关节置换术（TKA）和腰椎手术已被报道会相互影响各自的结果。对于同时患有两种症状相当的疾病的患者，尚无足够的证据来指导治疗顺序的选择。
设计了五个同时存在的、晚期的、退行性膝和腰椎疾病的临床情景，以调查外科医生对治疗顺序和治疗原理的选择。脊柱疾病始终为退行性腰椎狭窄症，但膝关节疾病则有所不同，包括（1）伴有内翻畸形的骨关节炎（OA），（2）伴有外翻畸形的 OA，（3）伴有严重屈曲挛缩的类风湿关节炎，（4）无畸形的 OA，和（5）双侧 OA 伴风摆畸形。该调查分发给北美膝关节协会和脊柱侧凸研究协会的选定临床成员。比较了 5 种情况下外科医生的选择，并使用文本挖掘对他们的评论进行了分析。
收到了 74 名膝关节置换外科医生中的 42 名（57%）和 100 名脊柱外科医生中的 55 名（55%）的回复。膝关节置换外科医生推荐“先进行 TKA”的比例在不同情况下有显著差异：分别为 29%、79%、55%、7%和 81%（P<0.001）。脊柱外科医生也出现了类似的模式。
对于同时患有退行性膝和腰椎疾病的患者，膝关节畸形的严重程度和类型会影响两个专业的治疗顺序偏好。严重的外翻畸形和风摆畸形会促使人们倾向于“先进行 TKA”。
