{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T19:07:14Z","timestamp":1783969634684,"version":"3.55.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The impact of clinically symptomatic spine comorbidities on patient-reported outcomes after total knee arthroplasty (TKA) remains unclear. We hypothesized that patients with pre-TKA spine comorbidities would demonstrate inferior outcomes compared with those without spine comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively reviewed 492 patients who underwent primary TKA performed between 2020 and 2022. Spine comorbidities were defined as a history of lumbar injection, spine surgery, low back pain, or radiating pain. Three propensity score\u2013matched analyses were performed: (1) primary analysis comparing patients with pre-TKA spine comorbidities vs. controls (141 pairs; 1:1 matching), (2) secondary analysis excluding patients who developed post-TKA spine comorbidities to isolate the effect of preexisting spine conditions (127 pairs; 1:1 matching), and (3) subgroup analysis comparing patients with prior spine surgery vs. those without (47 vs. 138; 1:3 matching). The Knee injury and Osteoarthritis Outcome Score (KOOS) was assessed preoperatively and at 1 and 2 years postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>There were 282 patients (141 pairs) in the primary analysis cohort (mean age, 72 years; 85% female). KOOS Sport showed the most consistent between-group differences across analyses. In the primary analysis, KOOS Sport was significantly lower in the spine comorbidity group at 2 years after false discovery rate (FDR) correction (mean, 43.4 vs. 53.9; mean difference, \u221210.5; Cohen's d = \u22120.45). KOOS Total showed nominally lower scores, although this did not remain significant after multiplicity adjustment. In the secondary analysis, KOOS Symptoms (71.2 vs. 78.0), Sport (44.1 vs. 56.5), and Total scores (66.4 vs. 72.9) were significantly lower at 2 years after FDR correction. In the subgroup analysis, patients with prior spine surgery showed lower KOOS scores in unadjusted comparisons at 2 years, although none of these differences remained significant after FDR correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Pre-TKA spine comorbidities are associated with inferior KOOS outcomes, most consistently in high-demand activities. Awareness of these coexisting conditions may be helpful when counseling patients undergoing TKA about realistic expectations for postoperative functional recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level III<\/jats:underline>\n                      , Therapeutic Study. See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.26.00180","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T18:04:13Z","timestamp":1783965853000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Concomitant Spine Comorbidities on Patient-Reported Outcomes After Total Knee Arthroplasty"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6172-8383","authenticated-orcid":false,"given":"Jisoo","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0019-4947","authenticated-orcid":false,"given":"Heeyoon","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Geo-in Hospital, Busan, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6560-3510","authenticated-orcid":false,"given":"Won Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8597-1054","authenticated-orcid":false,"given":"Chong Bum","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea"},{"name":"Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"issue":"17","key":"R1-20260713","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1056\/NEJMoa1505467","article-title":"A randomized, controlled trial of total knee replacement","volume":"373","author":"Skou","year":"2015","journal-title":"N Engl J Med"},{"issue":"9823","key":"R2-20260713","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/S0140-6736(11)60752-6","article-title":"Knee replacement","volume":"379","author":"Carr","year":"2012","journal-title":"Lancet"},{"issue":"10158","key":"R3-20260713","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1016\/S0140-6736(18)32344-4","article-title":"Knee replacement","volume":"392","author":"Price","year":"2018","journal-title":"Lancet"},{"issue":"2","key":"R4-20260713","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1007\/s11999-009-1046-9","article-title":"Comparing patient outcomes after THA and TKA: is there a difference?","volume":"468","author":"Bourne","year":"2010","journal-title":"Clin Orthop Relat Res"},{"issue":"9","key":"R5-20260713","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1302\/0301-620X.92B9.24394","article-title":"Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients","volume":"92-B","author":"Scott","year":"2010","journal-title":"J Bone Joint Surg Br"},{"issue":"8","key":"R6-20260713","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1302\/0301-620X.94B8.28786","article-title":"The effect of surgical factors on early patient-reported outcome measures (PROMS) following total knee replacement","volume":"94-B","author":"Baker","year":"2012","journal-title":"J Bone Joint Surg Br"},{"issue":"2","key":"R7-20260713","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1302\/0301-620X.100B2.BJJ-2017-1016.R1","article-title":"Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late","volume":"100-B","author":"Clement","year":"2018","journal-title":"Bone Joint J"},{"issue":"10","key":"R8-20260713","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1007\/s00264-020-04607-9","article-title":"Why are patients dissatisfied following a total knee replacement? A systematic review","volume":"44","author":"Nakano","year":"2020","journal-title":"Int Orthop"},{"issue":"7","key":"R9-20260713","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1016\/j.arth.2015.01.039","article-title":"Predictors of satisfaction following total knee arthroplasty","volume":"30","author":"Maratt","year":"2015","journal-title":"J Arthroplasty"},{"issue":"12","key":"R10-20260713","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1302\/0301-620X.95B12.31684","article-title":"Total knee replacement in patients with concomitant back pain results in a worse functional outcome and a lower rate of satisfaction","volume":"95-B","author":"Clement","year":"2013","journal-title":"Bone Joint J"},{"issue":"6","key":"R11-20260713","doi-asserted-by":"crossref","first-page":"S103","DOI":"10.1016\/j.arth.2023.03.072","article-title":"How back pain affects patient satisfaction after primary total knee arthroplasty","volume":"38","author":"Ayers","year":"2023","journal-title":"J Arthroplasty"},{"issue":"12","key":"R12-20260713","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1007\/s00402-016-2576-8","article-title":"Concomitant low back pain impairs outcomes after primary total knee arthroplasty in patients over 65 years: a prospective, matched cohort study","volume":"136","author":"Collados-Maestre","year":"2016","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"R13-20260713","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1007\/s11999-013-3298-7","article-title":"Coexisting lumbar spondylosis in patients undergoing TKA: how common and how serious?","volume":"472","author":"Chang","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"5","key":"R14-20260713","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.arth.2013.10.001","article-title":"Total joint arthroplasty and preoperative low back pain","volume":"29","author":"Staibano","year":"2014","journal-title":"J Arthroplasty"},{"issue":"3","key":"R15-20260713","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1097\/00007632-198304000-00014","article-title":"Hip-spine syndrome","volume":"8","author":"Offierski","year":"1983","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"R16-20260713","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.arth.2024.08.028","article-title":"Preoperative abnormal posture improves after total knee arthroplasty: knee-hip-spine syndrome","volume":"40","author":"Oshima","year":"2025","journal-title":"J Arthroplasty"},{"issue":"5","key":"R17-20260713","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1007\/s00586-013-2661-4","article-title":"The effect of simulated knee flexion on sagittal spinal alignment: novel interpretation of spinopelvic alignment","volume":"22","author":"Lee","year":"2013","journal-title":"Eur Spine J"},{"issue":"10","key":"R18-20260713","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1016\/j.joca.2018.06.012","article-title":"Interaction between low back pain and knee pain contributes to disability level in individuals with knee osteoarthritis: a cross-sectional study","volume":"26","author":"Iijima","year":"2018","journal-title":"Osteoarthritis Cartilage"},{"issue":"1","key":"R19-20260713","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1302\/0301-620X.85B1.13389","article-title":"The knee-spine syndrome. Association between lumbar lordosis and extension of the knee","volume":"85-B","author":"Murata","year":"2003","journal-title":"J Bone Joint Surg Br"},{"issue":"6","key":"R20-20260713","doi-asserted-by":"crossref","first-page":"S330","DOI":"10.1016\/j.arth.2020.02.031","article-title":"Stiffness after total knee arthroplasty: is it a result of spinal deformity?","volume":"35","author":"Vigdorchik","year":"2020","journal-title":"J Arthroplasty"},{"issue":"1","key":"R21-20260713","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s13018-023-03605-y","article-title":"Spondylolisthesis and mismatch deformity affect outcomes after total knee arthroplasty","volume":"18","author":"Sheppard","year":"2023","journal-title":"J Orthop Surg Res"},{"issue":"2","key":"R22-20260713","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1056\/NEJM199407143310201","article-title":"Magnetic resonance imaging of the lumbar spine in people without back pain","volume":"331","author":"Jensen","year":"1994","journal-title":"N Engl J Med"},{"issue":"12","key":"R23-20260713","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.3174\/ajnr.A4498","article-title":"MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis","volume":"36","author":"Brinjikji","year":"2015","journal-title":"AJNR Am J Neuroradiol"},{"issue":"3","key":"R24-20260713","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s00590-021-03010-3","article-title":"Presence of back pain prior total knee arthroplasty and its effects on short-term patient-reported outcome measures","volume":"32","author":"Singh","year":"2022","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"1","key":"R25-20260713","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s43019-025-00267-4","article-title":"Total knee arthroplasty in patients with degenerative spine disease: does spinal fusion affect outcomes? A matched comparative analysis using a national database","volume":"37","author":"Daher","year":"2025","journal-title":"Knee Surg Relat Res"},{"issue":"2","key":"R26-20260713","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pst.433","article-title":"Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm Stat"},{"issue":"2","key":"R27-20260713","doi-asserted-by":"crossref","first-page":"88","DOI":"10.2519\/jospt.1998.28.2.88","article-title":"Knee injury and osteoarthritis outcome score (KOOS)--development of a self-administered outcome measure","volume":"28","author":"Roos","year":"1998","journal-title":"J Orthop Sports Phys Ther"},{"key":"R28-20260713","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1477-7525-1-17","article-title":"Knee injury and osteoarthritis outcome score (KOOS) - validation and comparison to the WOMAC in total knee replacement","volume":"1","author":"Roos","year":"2003","journal-title":"Health Qual Life Outcomes"},{"issue":"4","key":"R29-20260713","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.gaitpost.2008.05.008","article-title":"A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome","volume":"28","author":"Harato","year":"2008","journal-title":"Gait Posture"},{"key":"R30-20260713","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.knee.2021.02.027","article-title":"Relationships between the changes in flexion contracture and standing flexion angle of the knee and sagittal spinal alignment after total knee arthroplasty","volume":"29","author":"Han","year":"2021","journal-title":"Knee"},{"issue":"22","key":"R31-20260713","doi-asserted-by":"crossref","first-page":"E1282","DOI":"10.1097\/BRS.0000000000002157","article-title":"Defining the role of the lower limbs in compensating for sagittal malalignment","volume":"42","author":"Lafage","year":"2017","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"R32-20260713","doi-asserted-by":"crossref","first-page":"9","DOI":"10.31616\/asj.2019.0359","article-title":"Spinopelvic alignment and low back pain before and after total knee arthroplasty","volume":"15","author":"Kitagawa","year":"2021","journal-title":"Asian Spine J"},{"issue":"5","key":"R33-20260713","doi-asserted-by":"crossref","first-page":"e2110715","DOI":"10.1001\/jamanetworkopen.2021.10715","article-title":"Association of lumbar spine radiographic changes with severity of back pain-related disability among middle-aged, community-dwelling women","volume":"4","author":"Chen","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"5","key":"R34-20260713","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1016\/j.arth.2017.11.021","article-title":"The impact of spino-pelvic alignment on total hip arthroplasty outcomes: a critical analysis of current evidence","volume":"33","author":"Sultan","year":"2018","journal-title":"J Arthroplasty"},{"issue":"6","key":"R35-20260713","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1302\/0301-620X.99B6.BJJ-2016-0577.R2","article-title":"Lumbar surgery prior to total hip arthroplasty is associated with worse patient-reported outcomes","volume":"99-B","author":"Eneqvist","year":"2017","journal-title":"Bone Joint J"},{"issue":"22","key":"R36-20260713","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The oswestry disability index","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.2106\/JBJS.OA.26.00180","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T19:00:13Z","timestamp":1783969213000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.2106\/JBJS.OA.26.00180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.26.00180","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}