膝关节骨关节炎和关节置换术对成人脊柱畸形患者全身矢状面排列的影响。

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

作者信息

Daher Mohammad, Daniels Alan H, Knebel Ashley, Balmaceno-Criss Mariah, Lafage Renaud, Lenke Lawrence G, Ames Chrisotpher P, Burton Douglas, Lewis Stephen M, Klineberg Eric O, Eastlack Robert K, Gupta Munish C, Mundis Gregory M, Gum Jeffrey L, Hamilton Kojo D, Hostin Richard, Passias Peter G, Protopsaltis Themistocles S, Kebaish Khaled M, Kim Han Jo, Schwab Frank, Shaffrey Christopher I, Smith Justin S, Line Breton, Bess Shay, Lafage Virginie, Diebo Bassel G

机构信息

Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI.

Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY.

出版信息

Spine (Phila Pa 1976). 2025 Apr 15;50(8):508-514. doi: 10.1097/BRS.0000000000005206. Epub 2024 Nov 6.

DOI:10.1097/BRS.0000000000005206

PMID:39505566

Abstract

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.

摘要

研究设计

对前瞻性收集的数据进行回顾性分析。

目的

本研究评估膝骨关节炎（OA）和膝关节置换术对接受成人脊柱畸形（ASD）矫正手术患者的对线情况及患者报告结局指标（PROMS）的影响。

背景

ASD患者中膝OA与脊柱对线之间的关系尚未完全明确。膝置换合并ASD的患者与有天然膝关节的ASD患者相比情况如何也尚不清楚。

方法

使用基线全身X线片，由两名独立的评估者根据KL分级对髋和膝OA进行分级。比较不同膝OA组之间的脊柱骨盆参数和PROMS，并比较膝关节置换患者与有天然膝关节患者之间的情况。

结果

199例双侧非重度OA患者（G1组），31例单侧重度膝OA患者（G2组），60例双侧重度膝OA患者（G3组）。重度膝OA患者的脊柱骨盆参数更差。然而，在控制年龄、虚弱程度、骨盆入射角（PI）、胸椎矢状面倾斜角（T1PA）进行多变量回归分析后，膝OA是膝关节屈曲（G1组：-0.02±7.3，G2组：7.8±9.4，G3组：4.5±8.7，P <0.001）和踝关节背屈（G1组：2.3±4.0，G2组：6.6±4.5，G3组：5.1±4.1，P <0.001）的独立预测因素。患者报告结局指标方面无差异（P>0.05）。二次分析纳入96例患者：48例（50%）非重度膝OA患者和48例（50%）膝关节置换患者。两组之间的影像学参数或患者报告结局指标无差异。