Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2025; 16(7): 107869
Published online Jul 18, 2025. doi: 10.5312/wjo.v16.i7.107869
Effect of total knee arthroplasty on the spinopelvic parameters: A systemic review and metanalysis
Mantu Jain, Deb Kumar Pal, Rabi Narayan Sahu, Bikash Ranjan Meher, Binod Kumar Patro, Sujit Kumar Tripathy
Mantu Jain, Sujit Kumar Tripathy, Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
Deb Kumar Pal, Binod Kumar Patro, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India
Rabi Narayan Sahu, Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India
Bikash Ranjan Meher, Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India
Author contributions: Jain M, Pal DK, and Tripathy SK designed the research study; Jain M, Pal DK, Sahu RN, Meher BR, Patro BK, and Tripathy SK performed the research; All of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: There is no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sujit Kumar Tripathy, Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar 751019, Odisha, India. ortho_sujit@aiimsbhubaneswar.edu.in
Received: April 2, 2025
Revised: April 29, 2025
Accepted: June 20, 2025
Published online: July 18, 2025
Processing time: 109 Days and 17.2 Hours
Abstract
BACKGROUND

Sagittal spinopelvic alignment (SSA) is essential for preserving a stable and effective upright posture and locomotion. Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis, hips, and knees, the inverse relationship concerning knee pathology undergoing total knee arthroplasty (TKA) has been examined by a limited number of studies, yielding inconclusive results.

AIM

To generate evidence of the effect of TKA on the SSA from existing literature.

METHODS

Databases like PubMed, EMBASE, and Scopus were used to identify articles related to the “knee spine syndrome” phenomenon using a combination of subject terms and keywords such as “spinopelvic parameters”, “sagittal spinal balance”, and “total knee arthroplasty” were used with appropriate Boolean operators. Studies measuring the SSA following TKA were included, and research was conducted as per preferred reporting items for systematic review and meta-analysis guidelines.

RESULTS

A total of 475 participants had undergone TKA, and six studies measuring SSA were analysed. Following TKA, pelvic tilt was the only parameter that showed significant changes, while lumbar lordosis (LL), pelvic incidence, and sacral slope were non-significant, as evident from the forest plots.

CONCLUSION

The body's sagittal alignment is a complex balance between pelvic, spine, and lower extremity parameters. TKA, while having the potential to correct the flexion contracture, can also correct it. Still, the primary SSA for spinal pathology, i.e., LL, may not be corrected in patients with co-existent spinal degenerative disease.

Keywords: Spinopelvic parameters; Total knee arthroplasty; Pelvic parameters; Lower extremities parameters; Meta-analysis

Core Tip: Sagittal spinopelvic alignment (SSA) plays a critical role in maintaining upright posture and mobility. While spinal alignment changes are known to cause compensatory shifts in the pelvis, hips, and knees, few studies have explored the reverse relationship, particularly in patients undergoing total knee arthroplasty (TKA), with inconclusive findings. SSA represents a complex interaction among pelvic, spinal, and lower limb structures. Although TKA can improve knee flexion contractures, it may not fully address lumbar lordosis, especially in individuals with concurrent spinal degenerative conditions, limiting overall sagittal correction.