Incidence of Lumbar Spondylolisthesis in Patients Candidate for Total Knee Replacement

Background: Lumbar spondylolisthesis and knee osteoarthritis (OA) are prevalent conditions in the elderly population. The presence of lumbar spine complaints clearly exacerbates overall symptoms and deteriorates function in knee osteoarthritis patients undergoing total knee arthroplasty. Aim: The aim of this study was to determine the incidence and characteristics of lumbar spondylolisthesis in patients with advanced knee osteoarthritis undergoing TKR primarily and assess the effect of TKR on knee function and pain, low back pain, lower limb mechanical alignment, and postoperative changes in lumbar lordosis. Patients and methods: This prospective research involved 210 patients with primary advanced knee osteoarthritis receiving total knee replacement at Assiut University Hospital. Clinical assessment was conducted with the Oxford Knee Score (OKS), Knee Society Score (KSS), and Oswestry Disability Index (ODI). The radiological assessment encompassed the measurement of lumbar spondylolisthesis, lumbar lordosis, and the hip-kneeankle (HKA) angle both preoperatively and postoperatively. Results: Lumbar spondylolisthesis was identified in 50.5% of individuals. No statistically significant difference was noted between men and females; however, a markedly greater frequency was detected in individuals with elevated BMI compared to those with normal BMI. Postoperatively, there was a statistically significant enhancement in knee pain and function, evidenced by elevated OKS and KSS scores, along with a notable decrease in ODI values. A statistically significant enhancement in the hip–knee–ankle angle was noted postTKR, signifying rectification of lower limb mechanical alignment. Furthermore, lumbar lordosis exhibited a statistically significant enhancement postoperatively. Nonetheless, no notable radiological alteration was seen in the extent of lumbar spondylolisthesis. Conclusion: Lumbar spondylolisthesis is common in patients undergoing TKR, particularly in those with increased BMI. TKR significantly improves knee function, spinal symptoms, lower limb alignment, and lumbar lordosis, without altering the radiological grade of spondylolisthesis.