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

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

doi:10.1097/BRS.0000000000005206

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

Spine (Phila Pa 1976). 2024 Nov 6. doi: 10.1097/BRS.0000000000005206. Online ahead of print.

Authors

Mohammad Daher¹, Alan H Daniels¹, Ashley Knebel¹, Mariah Balmaceno-Criss¹, Renaud Lafage², Lawrence G Lenke³, Chrisotpher P Ames⁴, Douglas Burton⁵, Stephen M Lewis⁶, Eric O Klineberg⁷, Robert K Eastlack⁸, Munish C Gupta⁹, Gregory M Mundis⁸, Jeffrey L Gum¹⁰, Kojo D Hamilton¹¹, Richard Hostin¹², Peter G Passias¹³, Themistocles S Protopsaltis¹³, Khaled M Kebaish¹⁴, Han Jo Kim¹⁵, Frank Schwab², Christopher I Shaffrey¹⁶, Justin S Smith¹⁷, Breton Line¹⁸, Shay Bess¹⁸, Virginie Lafage², Bassel G Diebo¹; International Spine Study Group (ISSG)

Affiliations

¹ Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
² Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA.
³ Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA.
⁴ Department of Neurological Surgery, University of California, San Francisco, California, USA.
⁵ Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
⁶ Department of Orthopedics, University of Toronto, Toronto, Canada.
⁷ Department of Orthopedic Surgery, University of Texas McGovern Medical School, Houston, Texas, USA.
⁸ Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA.
⁹ Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA.
¹⁰ Norton Leatherman Spine Center, Louisville, Kentucky, USA.
¹¹ Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹² Southwest Scoliosis and Spine Institute, Plano, Texas, USA.
¹³ Department of Orthopedics, New York University Langone Orthopedic Hospital, New York, New York, USA.
¹⁴ Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁵ Hospital for Special Surgery, New York, New York, USA.
¹⁶ Department of Neurosurgery, Duke Spine Division, Durham, North Carolina, USA.
¹⁷ Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.
¹⁸ Department of Spine Surgery, Denver International Spine Center, Denver, Colorado, USA.

PMID: 39505566
DOI: 10.1097/BRS.0000000000005206

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: 199 patients with bilateral non severe 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 non-severe knee OA, and 48 patients (50%) with knee replacement. There was no difference in radiographic parameters or PROMs between the groups.

Conclusion: In this study of complex ASD patients, patients with worse spinal deformity 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.