title: Total knee replacement in patients with concomitant back pain results in a worse functional outcome and a lower rate of satisfaction.
abstract: This study assessed the effect of concomitant back pain on the Oxford knee score (OKS), Short-Form (SF)-12 and patient satisfaction after total knee replacement (TKR). It involved a prospectively compiled database of demographics and outcome scores for 2392 patients undergoing primary TKR, of whom 829 patients (35%) reported back pain. Compared with those patients without back pain, those with back pain were more likely to be female (odds ratio (OR) 1.5 (95% confidence interval (CI) 1.3 to 1.8)), have a greater level of comorbidity, a worse pre-operative OKS (2.3 points (95% CI 1.7 to 3.0)) and worse SF-12 physical (2.0 points (95% CI 1.4 to 2.6)) and mental (3.3 points (95% CI 2.3 to 4.3)) components. One year post-operatively, those with back pain had significantly worse outcome scores than those without with a mean difference in the OKS of 5 points (95% CI 3.8 to 5.4), in the SF-12 physical component of 6 points (95% CI 5.4 to 7.1) and in the mental component of 4 points (95% CI 3.1 to 4.9). Patients with back pain were less likely to be satisfied (OR 0.62, 95% CI 0.5 to 0.78). After adjusting for confounding variables, concomitant back pain was an independent predictor of a worse post-operative OKS, and of dissatisfaction. Clinicians should be aware that patients suffering concomitant back pain pre-operatively are at an increased risk of being dissatisfied post-operatively.
authors.affiliation: Royal Infirmary of Edinburgh, Department of Orthopaedics and Trauma, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.forename: D
authors.initials: D
authors.lastname: MacDonald
authors.forename: A H R W
authors.initials: AH
authors.lastname: Simpson
authors.forename: R
authors.initials: R
authors.lastname: Burnett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D001416:Back Pain / Q000150:complications*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012606:Scotland; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Back pain; Lumbar; Outcome; Satisfaction; TKR; Total knee replacement