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J Knee Surg 2022; 35(13): 1409-1416
DOI: 10.1055/s-0041-1723979
Original Article

Lumbar Spine Sagittal Mismatch Deformity Negatively Affects Total Knee Arthroplasty Outcomes

William L. Sheppard 
1   Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California
,
Alexander Upfill-Brown 
1   Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California
,
Kevin M. McKay
2   David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
,
Howard Y. Park
1   Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California
,
Akash Shah
1   Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California
,
Don Y. Park
1   Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California
2   David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
,
Adam A. Sassoon
1   Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California
2   David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
› Author Affiliations Funding None.
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Abstract

There is currently a paucity of data regarding the potential relationships between preexisting spinal deformity and clinical outcomes following total knee arthroplasty (TKA). We sought to expand upon this deficit. We hypothesize that lumbar sagittal mismatch deformity (MD) will correlate with a decrease in functional outcomes after TKA. 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 sagittal parameters of interest: pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, and deformity mismatch. Ninety-four TKAs were subsequently available for inclusion and divided into two groups: those with MD as defined by |PI-LL| > 10 degrees and those without MD. The following clinical outcomes were compared between the groups: total postoperative arc of motion (AOM), incidence of flexion contracture, and need for manipulation under anesthesia (MUA). In total, 53 TKAs met the MD criteria, while 41 did not have MD. There were no significant differences in demographics, body mass index, preoperative knee range of motion (ROM), preoperative AOM, or opiate use between the groups. TKAs with MD were more likely to have MUA (p = 0.026), ROM <0 to 120 (p < 0.001), a decreased AOM by 16 degrees (p < 0.001), and a flexion contracture postoperatively (p = 0.01). Preexisting MD may adversely affect clinical results following TKA. Statistically and clinically significant decreases in postoperative ROM/AOM, increased likelihood of flexion contracture, and increased need for MUA were all noted in those with MD. This is a Level 3 study.

Keywords

spine - deformity - outcomes - knee - arthroplasty


Publication History

Received: 19 August 2020

Accepted: 02 January 2021

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

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