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Published in: Clinical Orthopaedics and Related Research® 10/2009

01-10-2009 | Original Article

Does Concomitant Low Back Pain Affect Revision Total Knee Arthroplasty Outcomes?

Authors: Wendy M. Novicoff, PhD, David Rion, BS, William M. Mihalko, MD, PhD, Khaled J. Saleh, MD, MSc

Published in: Clinical Orthopaedics and Related Research® | Issue 10/2009

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Abstract

The number of revision total knee arthroplasties (rev-TKA) is increasing every year. These cases are technically difficult and add considerable burden on the healthcare system. Many patients have concomitant low back pain that may interfere with functional outcome. We asked whether having low back pain at baseline would influence amount and rate of improvement on standardized outcomes measures after rev-TKA. We retrospectively reviewed 308 patients from prospectively collected data in a multicenter study. A minimum 24-month followup was available for 221 patients (71.8%). Patients with low back pain at baseline had worse scores on most instruments than their counterparts at baseline, 12 months postsurgery, and 24 months postsurgery. The data suggest concomitant back pain in patients undergoing rev-TKA affects their outcomes as measured by standardized instruments. Orthopaedic surgeons should counsel their patients with back pain regarding the possibility of slower or less complete recovery.
Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
2.
go back to reference Bellamy N, Buchanan WW. Outcome measurement in osteoarthritis clinical trials: the case for standardization. Clin Rheumatol. 1984;3:293–303.PubMedCrossRef Bellamy N, Buchanan WW. Outcome measurement in osteoarthritis clinical trials: the case for standardization. Clin Rheumatol. 1984;3:293–303.PubMedCrossRef
3.
go back to reference Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMed Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMed
4.
go back to reference Bozic KJ, Durbhakula S, Berry DJ, Naessens JM, Rappaport K, Cisternas M, Saleh KJ, Rubash HE. Differences in patient and procedure characteristics and hospital resource use in primary and revision total joint arthroplasty: a multicenter study. J Arthroplasty. 2005;20(suppl 3):17–25.PubMedCrossRef Bozic KJ, Durbhakula S, Berry DJ, Naessens JM, Rappaport K, Cisternas M, Saleh KJ, Rubash HE. Differences in patient and procedure characteristics and hospital resource use in primary and revision total joint arthroplasty: a multicenter study. J Arthroplasty. 2005;20(suppl 3):17–25.PubMedCrossRef
5.
go back to reference Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement: a meta-analysis. JAMA. 1994;271:1349–1357.PubMedCrossRef Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement: a meta-analysis. JAMA. 1994;271:1349–1357.PubMedCrossRef
6.
go back to reference Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res. 2006;443:266–272.PubMedCrossRef Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res. 2006;443:266–272.PubMedCrossRef
7.
go back to reference Deshmukh RV, Scott RD. Unicompartmental knee arthroplasty: long-term results. Clin Orthop Relat Res. 2001;392:272–278.PubMedCrossRef Deshmukh RV, Scott RD. Unicompartmental knee arthroplasty: long-term results. Clin Orthop Relat Res. 2001;392:272–278.PubMedCrossRef
8.
go back to reference Escobar A, Quintana JM, Bilbao A, Azkarate J, Guenaga JI, Arenaza JC, Gutierrez LF. Effect of patient characteristics on reported outcomes after total knee replacement. Rheumatology. 2007;46:112–119.PubMedCrossRef Escobar A, Quintana JM, Bilbao A, Azkarate J, Guenaga JI, Arenaza JC, Gutierrez LF. Effect of patient characteristics on reported outcomes after total knee replacement. Rheumatology. 2007;46:112–119.PubMedCrossRef
9.
go back to reference Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86:963–974.PubMed Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86:963–974.PubMed
10.
go back to reference Hartley RC, Barton-Hanson NG, Finley R, Parkinson RW. Early patient outcomes after primary and revision total knee arthroplasty: a prospective study. J Bone Joint Surg Br. 2002;84:994–999.PubMedCrossRef Hartley RC, Barton-Hanson NG, Finley R, Parkinson RW. Early patient outcomes after primary and revision total knee arthroplasty: a prospective study. J Bone Joint Surg Br. 2002;84:994–999.PubMedCrossRef
11.
go back to reference Hawker G, Melfi C, Paul J, Green R, Bombardier C. Comparison of a generic (SF-36) and a disease specific (WOMAC) (Western Ontario and McMaster Universities Osteoarthritis Index) instrument in the measurement of outcomes after knee replacement surgery. J Rheumatol. 1995;22:1193–1196.PubMed Hawker G, Melfi C, Paul J, Green R, Bombardier C. Comparison of a generic (SF-36) and a disease specific (WOMAC) (Western Ontario and McMaster Universities Osteoarthritis Index) instrument in the measurement of outcomes after knee replacement surgery. J Rheumatol. 1995;22:1193–1196.PubMed
12.
go back to reference Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D. Health-related quality of life after knee replacement. J Bone Joint Surg Am. 1998;80:163–173.PubMed Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D. Health-related quality of life after knee replacement. J Bone Joint Surg Am. 1998;80:163–173.PubMed
13.
go back to reference Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop Relat Res. 1998;356:93-110.PubMedCrossRef Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop Relat Res. 1998;356:93-110.PubMedCrossRef
14.
go back to reference Insall JN, Dorr LD, Scott RD, Norman WS. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMed Insall JN, Dorr LD, Scott RD, Norman WS. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMed
15.
go back to reference Kane RL, Saleh KJ, Wilt TJ, Bershadsky B. The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2005;87:1719–1724.PubMedCrossRef Kane RL, Saleh KJ, Wilt TJ, Bershadsky B. The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2005;87:1719–1724.PubMedCrossRef
16.
go back to reference Kane RL, Saleh KJ, Wilt TJ, Bershadsky B, Cross WW III, MacDonald RM, Rutks I. Total knee replacement. Evid Rep Technol Assess (Summ). 2003;86:1–8. Kane RL, Saleh KJ, Wilt TJ, Bershadsky B, Cross WW III, MacDonald RM, Rutks I. Total knee replacement. Evid Rep Technol Assess (Summ). 2003;86:1–8.
17.
go back to reference Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Golish JD. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther. 2008;88:22–32.PubMed Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Golish JD. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther. 2008;88:22–32.PubMed
18.
go back to reference Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–1497.PubMedCrossRef Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–1497.PubMedCrossRef
19.
go back to reference Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRef Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRef
20.
go back to reference Kurtz SM, Ong KL, Schmier J, Zhao K, Mowat F, Lau E. Primary and revision arthroplasty surgery caseloads in the United States from 1990 to 2004. J Arthroplasty. 2009;24:195–203.PubMedCrossRef Kurtz SM, Ong KL, Schmier J, Zhao K, Mowat F, Lau E. Primary and revision arthroplasty surgery caseloads in the United States from 1990 to 2004. J Arthroplasty. 2009;24:195–203.PubMedCrossRef
21.
go back to reference Lavernia C, Lee DJ, Hernandez VH. The increasing financial burden of knee revision surgery in the United States. Clin Orthop Relat Res. 2006;446:221–226.PubMedCrossRef Lavernia C, Lee DJ, Hernandez VH. The increasing financial burden of knee revision surgery in the United States. Clin Orthop Relat Res. 2006;446:221–226.PubMedCrossRef
22.
go back to reference Lequesne M. Indices of severity and disease activity for osteoarthritis. Semin Arthritis Rheum. 1991;20(6):48–54.PubMedCrossRef Lequesne M. Indices of severity and disease activity for osteoarthritis. Semin Arthritis Rheum. 1991;20(6):48–54.PubMedCrossRef
23.
go back to reference Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax Outcomes Group. Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am. 2001;83:1856–1864.PubMed Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax Outcomes Group. Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am. 2001;83:1856–1864.PubMed
24.
go back to reference McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66.PubMedCrossRef McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66.PubMedCrossRef
25.
go back to reference McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–263.PubMedCrossRef McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–263.PubMedCrossRef
26.
go back to reference National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheum. 2008;58:26–35.CrossRef National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheum. 2008;58:26–35.CrossRef
27.
go back to reference National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health and Human Services. Handout on Health: Backpain. Bethesda, MD: National Institutes of Health; 2005. NIH Publication No 05-5282. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health and Human Services. Handout on Health: Backpain. Bethesda, MD: National Institutes of Health; 2005. NIH Publication No 05-5282.
28.
go back to reference Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty: cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am. 1991;73:397–409.PubMed Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty: cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am. 1991;73:397–409.PubMed
29.
go back to reference Rasanen P, Paavolainen P, Sintonen H, Koivisto AM, Blom M, Ryynanen OP, Roine RP. Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop. 2007;78:108–115. PubMedCrossRef Rasanen P, Paavolainen P, Sintonen H, Koivisto AM, Blom M, Ryynanen OP, Roine RP. Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop. 2007;78:108–115. PubMedCrossRef
30.
go back to reference Saleh KJ, Mulhall K, Bershadsky B, Ghomrawi H, White LE, Buyea CM, Krackow K. Development and validation of a lower-extremity activity scale: use for patients treated with revision total knee arthroplasty. J Bone Joint Surg Am. 2005;87:1985–1994.PubMedCrossRef Saleh KJ, Mulhall K, Bershadsky B, Ghomrawi H, White LE, Buyea CM, Krackow K. Development and validation of a lower-extremity activity scale: use for patients treated with revision total knee arthroplasty. J Bone Joint Surg Am. 2005;87:1985–1994.PubMedCrossRef
31.
go back to reference Saleh KJ, Santos ER, Ghomrawi HM, Parvizi J, Muhall KJ. Socioeconomic issues and demographics of total knee arthroplasty revision. Clin Orthop Relat Res. 2006;446:15–21.PubMedCrossRef Saleh KJ, Santos ER, Ghomrawi HM, Parvizi J, Muhall KJ. Socioeconomic issues and demographics of total knee arthroplasty revision. Clin Orthop Relat Res. 2006;446:15–21.PubMedCrossRef
32.
go back to reference Shields RK, Enloe LJ, Leo KC. Health related quality of life in patients with total hip or knee replacement. Arch Phys Med Rehabil. 1999;80:572–579.PubMedCrossRef Shields RK, Enloe LJ, Leo KC. Health related quality of life in patients with total hip or knee replacement. Arch Phys Med Rehabil. 1999;80:572–579.PubMedCrossRef
33.
go back to reference Ware JE Jr, Sherborne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–483.PubMedCrossRef Ware JE Jr, Sherborne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–483.PubMedCrossRef
34.
go back to reference Whitehouse SL, Lingard EA, Katz JN, Learmonth ID. Development and testing of a reduced WOMAC function scale. J Bone Joint Surg Br. 2003;85:706–711.PubMed Whitehouse SL, Lingard EA, Katz JN, Learmonth ID. Development and testing of a reduced WOMAC function scale. J Bone Joint Surg Br. 2003;85:706–711.PubMed
Metadata
Title
Does Concomitant Low Back Pain Affect Revision Total Knee Arthroplasty Outcomes?
Authors
Wendy M. Novicoff, PhD
David Rion, BS
William M. Mihalko, MD, PhD
Khaled J. Saleh, MD, MSc
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 10/2009
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-009-0882-y

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