Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2022; 10(21): 7348-7355
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7348
Effect of osteoarthritic knee flexion deformity correction by total knee arthroplasty on sagittal spinopelvic alignment in Indian population
Lubaib Karaniveed Puthiyapura, Mantu Jain, Sujit Kumar Tripathy, Haridas Mundot Puliappadamb
Lubaib Karaniveed Puthiyapura, Mantu Jain, Sujit Kumar Tripathy, Department of Orthopaedics, AIIMS Bhubaneswar, Bhubaneswar 751019, Odisha, India
Haridas Mundot Puliappadamb, Department of Pharmacology, AIIMS Bhubaneswar, Bhubaneswar 751019, Odisha, India
Author contributions: Jain M conceived the idea with Tripathy SK and obtained ethical clearance for the study; Jain M, Tripathy SK and Puthiyapura LK were involved in sample collection; Puthiyapura LK followed up the cases and compiled the data; Puliappadamb HM did the statistics; Jain M and Puthiyapura LK wrote the manuscript with critical input provided by all authors; all authors have read and agree to content of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional ethics committee of AIIMS Bhubaneswar (IEC/AIIMS BBSR/PG Thesis/2019-20/94).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Mantu Jain, MD, Doctor, Surgeon, Department of Orthopaedics, AIIMS Bhubaneswar, Sijua, Bhubaneswar 751019, Odisha, India. montu_jn@yahoo.com
Received: January 15, 2022
Peer-review started: January 15, 2022
First decision: April 8, 2022
Revised: April 15, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: July 26, 2022
Processing time: 176 Days and 13.5 Hours
Abstract
BACKGROUND

Sagittal alignment of the spine, pelvis, and lower extremities is essential for maintaining a stable and efficient posture and ambulation. Imbalance in any element can result in compensatory changes in the other elements. Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis (OA). The correction of knee flexion deformity (KFD) by total knee arthroplasty (TKA) can lead to complementary changes in the sagittal spinopelvic parameters (SSPs).

AIM

To determine the SSP changes in patients with knee OA, with or without KFD undergoing TKA.

METHODS

The study was conducted in 32 patients who underwent TKA. A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients. Subjects were divided into two groups (Group 1 obtained > 10° corrections in KFD; group B obtained < 10° correction). The pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA) were measured.

RESULTS

The median of change in PT, PI, SS, LL, and SVA was 0.20 mm, 1.00 mm, 2.20 mm, −0.40 mm, and 6.8 mm, respectively. The difference in the change in SSPs between the two groups was statistically non-significant.

CONCLUSION

SSPs, such as PI, PT, SS, LL, and SVA, do not change significantly following TKA in end-stage knee OA despite a significant correction (> 10°) in KFD.

Keywords: Knee osteoarthritis; Total knee replacement; Spino-sagittal parameters; Knee flexion deformity

Core Tip: The sagittal alignment of the spine, pelvis, and lower extremities is essential for maintaining a stable and efficient posture and ambulation. Any imbalance in one element can result in compensatory changes in the other. Low back pain arising from hip pathology was termed “hip spine syndrome.” As the sagittal spinopelvic parameters (SSPs) were described, the researchers became inquisitive about documenting these changes in hip pathology and post-surgical correction. After two decades, the “knee spine syndrome” was described in a similar logical sequence. The SSPs have become an area of interest with several user-friendly tools to measure. The current papers evaluate these parameters in patients with osteoarthritis knee and undergoing total knee replacement.