Study | Design | Sample (sample size (number of males), laterality, knee condition) | Age (mean ± SD) | BMI (kg/m2) (mean ± SD) | Prevalence of reported LBP | Outcomes related to knee | Outcomes related to lumbar spine | Causation/relationships |
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Chang et al., 2014 [17] | Retrospective study | 225 (15 M) Laterality — NS Preoperative primary TKA due to advanced primary KOA | 69 + 6.5 | 26.8 + 3.5 | 100% | Pain, stiffness, physical function (WOMAC) Physical status (SF-36) | Pain VAS Radiographical changes | Diminished pain (β, 0.08, p = 0.28), physical function (β, −0.02, p = 0.80), and physical status (β, −0.001, p = 0.99): not associated with radiographic severity of lumbar spine degeneration LBP severe grade (VAS 7–10): associated with knee pain (regression coefficient with 95% CI −11.66 (−21.50 to −1.82)) Function: Affected by severe LBP (VAS scores 7–10) (regression coefficient with 95% CI −17.8 (−26.36 to −9.24)) Poorer function: Associated with moderate symptom grade (regression coefficient with 95% CI −5.64 (−12.24 to 1.07) Physical status: Affected by severe LBP (VAS scores 7–10) (regression coefficient with 95% CI −1.61 (−4.74 to −1.52) Radiographic lumbar spine degeneration: Found in all study subjects without exception (patients’ percentage below mentioned) • Mild degeneration: 11% • Moderate degeneration: 72% • Severe degeneration: 17% Lumbar spine symptoms LBP VAS scores (mean ± SD, 3.1 ± 2.7): Considerable proportion of patients had coexisting moderate to severe symptoms at the time of TKA (patients’ percentage below mentioned) • No/mild pain VAS 0–3 (60%) • Moderate pain VAS 4–6 (28%) • Severe pain VAS 7–10 (12%) |
Huang et al., 2014 [18] | RCT | Eight — severe bilateral KOA patients with chronic nonspecific LBP group Seven —healthy participants aged 23.00 (20.00/24.00) years, without OA, LBP, or other musculoskeletal symptoms (control group), 8 — bilateral KOA patients without LBP (NLBP group) | NS | NS | NS | Knee flexion Pain Functional disability of the patients with knee OA (Lequesne’s index scores) | Trunk flexion Pelvic anterior tilt Anterior trunk inclination angle Physical disability due to back pain (RDQ) Back pain intensity (ODI) | Trunk flexion angles (°): Smaller in KOA patients compared to healthy people without KOA or LBP (median (IQR), with LBP −27.65 (−33.07/−20.10); non-LBP −27.44 (−32.83/−24.30); healthy −40.43 (−46.46/−36.44)) Trunk rotation angle (°): Smaller in NLBP group than that of the controls (median (IQR), with NLBP 6.01 (3.89/8.23); controls 9.15 (6.57/10.25) Knee flexion angles in ipsilateral side of bending (°): Significantly smaller when doing the downward pickup movement in both the LBP and NLBP groups (median (IQR), with LBP −7.54 (−12.31/−3.78); non-LBP −6.39 (−12.95/−4.05); controls −19.89 (−31.63/−6.50)) Pelvic anterior tilt (°): Greater in KOA compared to the healthy people (median (IQR), with LBP −44.68 (−50.18/−40.52); NLBP −45.83 (−48.56/−39.38); healthy −32.61 (−37.05/−28.47)) Anterior trunk inclination angle(°): No significant difference between KOA and healthy people (median (IQR), with LBP −82.13 (−89.33/−73.23); NLBP −83.96 (−88.80/−74.07); controls −85.05 (−85.96/81.92) Physical disability: Higher in LBP group (median (IQR), with LBP 9 (7.3/10.8); non-LBP 3.5 (2.0/5.8)) Levels of back pain intensity component: Higher in LBP group (median (IQR), with LBP 1.0 (1.0/2.0); non-LBP 0.5 (0.0/1.0)) Pain and functional disability of the patients with knee OA: No statistically significant difference between LBP and non LBP (median (IQR), with LBP 11.0 (9.3/15.0); 13.0 (10.0/14.0)) |
Iijima et al., 2018 [8] | Cross-sectional study | 260 (22.3% M) — community-dwelling participants with knee OA (K/L grade ≥ 1), OA with LBP −151 and OA without LBP −109 | OA with LBP 68.6 ± 9.3, OA without LBP 70.7 ± 9.0 | OA with LBP 22.9 ± 3.7, OA without LBP 22.0 ± 3.2 | 58.1% | Knee pain severity and disability JKOM | Pain NRS | LBP: Associated with increased disability level (β: 0.69; 95% CI: 0.01 to 1.37) (p = 0.05) Relationships of LBP and disability level: Slightly increased in moderate to severe LBP (β:1.01; 95% CI: 0.22 to 1.80) (p = 0.01) Relationship between knee pain intensity and disability level: Higher in individuals with LBP (β: 0.62; 95% CI: 0.51 to 0.73) than in those without LBP (β: 0.40; 95% CI: 0.32 to 0.49) |
Iwamura et al., 2020 [19] | NS | 57 (10 M) DS patients who complicate KOA (KOA group), 127 (33 M) DS patients without KOA (non-KOA group) | 72.7 ± 7.0, 69.4 ± 8.2 | 24.5 ± 3.8, 22.8 ± 2.8 | NS | NS | Parameters in lumbo-pelvic sagittal alignment: PI, PT, LL, PI-LL, SS | Lumbo-pelvic sagittal alignment: Development and progression of KOA in DS patients is induced by significantly greater (p = 0.02) mismatches of lumbo-pelvic sagittal alignment Parameters in lumbo-pelvic sagittal alignment: PI (°); PT(°); LL(°); PI-LL and SS (°) of KOA group and non-KOA group were mean ± SD, 27.2 ± 9.8 and 22.2 ± 8.6, 40.4 ± 15.8 and 42.6 ± 14.3, 17.9 ± 15.1 and 10.3 ± 12.9, and 30.6 ± 10.0 and 30.6 ± 8.9, respectively Significant difference was observed in the rate of double adjacent level spondylolisthesis (p = 0.02) and in the following sagittal parameters: PT (p < 0.01), PI-LL (p < 0.01) |
Kohno et al., 2020 [20] | Retrospective study | Patients with DLS comorbid with 42-mild OA group, 28 — moderate OA group, 40 — severe OA group | 74 | 22.6 ± 3.2 23.4 ± 3.2 23.9 ± 2.9 | NS | KFA | PI PT | PI, PT, and KFA: Significantly greater in severe OA group, than mild OA group along with a smaller degree of LL than the mild-OA group preoperatively (all p < 0.05) PI (°): Significantly greater in severe OA group ( mean ± SD, 7 ± 8.7) than the mild OA group (51.8 ± 9.6) (p = 0.05) PT (°): Significantly greater in severe OA group ( mean ± SD, 28.8 ± 9.3) than the mild OA group (20.1 ± 8.3) (p < 0.01) LL (°): Significantly smaller in severe OA ( mean ± SD, 38.7 ± 12.2) than the mild OA (45.6 ± 13.0) (p = 0.04) KFA (°): Significantly greater in severe OA ( mean ± SD, 10.1 ± 5.3) group than the mild-OA (4.9 ± 6.8) group preoperatively (p = 0.02) Rate of radiographic ASD: Higher in the severe-OA group than in the mild-OA group (p = 0.02) patients percentage (38%) PT (°): Significantly greater in patients with ASD ( mean ± SD, 26.2 ± 7.0) in the severe-OA group than the patients without ASD (34.1 ± 10.8) (p = 0.02) LL (°): Less in patients with ASD (mean ± SD, 34.9 ± 14.6), than without ASD (40.6 ± 9.9) (p = 0.26) Rate of double-level listhesis: Significantly higher in the severe-OA group compared with the other groups (p = 0.01) (patients number %), mild OA group 12; moderate OA 31; severe OA 40 |
Staibano et al., 2014 [21] | Prospective cohort study | 491 (40.1% M) patients with end-stage KOA | 67.6 ± 9.6 | 31.9 ± 6.4 | 47.3% | NS | Back pain Degree of disability due to back pain (ODI) | Degree of disability due to back pain: Minimal (mean ± SD, 14.5 ±14) due to back pain in preoperative TKA patients with none or very mild LBP (p = 0.01) Pain on the ODI: Significantly higher among knee patients with a 68.4% (95% CI, 57.4–77.6%) |
Stupar et al., 2010 [12] | Population-based cohort study | 406 LBP | NS | NS | 58% | Pain, stiffness, and physical function (WOMAC) | NS | Pain and disability: Not associated with LBP in individuals with KOA (β = 0; 95% CI, −3.39 to 3.39; p = 0.99) |
Suri et al., 2010 [7] | NR | 1389 (40.1% M) people with KOA | 61.4 ± 9.1 | 30.2 ± 4.9 | 57.4% | Pain component (WOMAC) | NS | LBP: Significantly associated with increased functional score (β = 1; p < 0.01) (WOMAC score with LBP mean ± SD, 6.5 ± 4.1, without LBP 5.2 ± 3.4) |
Taniguchi et al., 2021 [23] | Cross-sectional | 586 (116 M) participants with x-ray-confirmed KOA | 68.8 ± 5.2 | NS | NS | Functional abilities related to knee (KSS) | Lumbar kyphosis | LBP and lumbar kyphosis: Independently associated with a lower function (LBP alone MD 95% CI, −4.96 (−7.56 to 13, −2.36); lumbar kyphosis alone, −4.47 (−8.51 to −0.43) Coexistence of LBP and lumbar kyphosis −13.86 (−18.86 to −8.86)) Coexistence of LBP and lumbar kyphosis: Was associated with a lower function in women (MD 95% CI −4.49 (−6.42 to −2.55)) |
Van Erp et al., 2020 [16] | Cohort study | 421 (116 M) hip and KOA | 56.1 ± 5 | 26.6 ± 4 | NS | NS | PI | PI (°): Significantly higher incidence of knee OA was observed in patients with a high PI, compared with those with normal PI (OR 1.70, 95% CI 1.07 to 2.71) (p = 0.02) or low PI (OR 1.62, 95% CI 1.04 to 2.53 (p = 0.03) High PI (> 60°): Is a risk factor for development of spondylolisthesis (L4 to L5, p = 0.02) and KOA (p = 0.03) |
Wang et al., 2016 [9] | Cross-sectional study | 59 (16) patients with severe KOA, 58 (14) asymptomatic persons free from KOA | 65.9, 62.9 | NS | 66.1% | NS | Sagittal alignment of the pelvis and hip: PI, PT, SS, PFA, SFA, FI, spinosacral angle, and C7 tilt | Sagittal alignment: No significant difference between KOA patients with and without LBP Comparable PI, SS, and PT values were revealed between the two groups, suggesting similar sagittal morphology and pelvic alignment PI (°): With LBP mean ± SD, (48.5 ± 10.4); without LBP (45.0 ± 10.0) (p = 0.68) SS (°): With LBP (36.2 ± 9.2); without LBP (32.9 ± 8.4) (p = 0.92) PT (°): With LBP (12.5 ± 6.3); without LBP (12.2 ± 7.1) (p = 0.32) Severe KOA patients showed significantly larger FI (11.3° versus 4.2°, p < 0.01) and smaller SFA (43.1° versus 51.8°, p < 0.01) and PFA (2.2° versus 9.1°, p < 0.01) values compared with controls These results indicate flexed knee and hip joints among patients with severe KOA C7 tilt: Significantly smaller among severe KOA patients compared with controls (88.4° versus 92.9°, p < 0.01), indicating forward inclination of the spine |
Wolfe et al., 1996 [6] | NS | 368 (23.1% M) diagnosed clinically as having KOA | NS | 31.0 | 54.6% | NS | Disability (HAQ) Pain VAS | Back pain: Strongly associated with knee pain (p = 0.03) Knee pain VAS (1–1.9): OR 2.18, 95% CI (2.03, 3.83) Knee pain VAS (≥ 2): OR 4.89, 95% CI (2.60, 9.20) Disability (p < 0.01): Strongly associated with back pain (p = 0.03) Disability (1–1.9): OR 2.12, 95% CI (1.37, 3.30) Disability (≥ 2): OR 6.84, 95% CI (2.87, 16.26) |
Yasuda et al., 2020 [22] | Large cohort study of volunteers | 396 (160 M) volunteers over 50 years of age | 74.4 | NS | NS | KL grading scale | Spinopelvic sagittal alignment: PT, PI, LL, thoracic kyphosis, and SVA, ODI | Lumbo-pelvic sagittal alignment: Poor in individuals over 50 years of age with severe KOA and has stronger relationship with progression severity of KOA in women than in men PT (°): Mean ± SD, KL1 (15.8 ± 7.5), KL2 (20.1 ± 8.8), KL3 (21.4 ± 9.2), KL4 (24.7 ± 9.5) (p = < 0.01) Degree of disability due to back pain: Progression severity of KOA had more impact on stronger relationship with disability-related LBP in (women > men) (p = 0.02) ODI score: KL1 ( mean ± SD, 9.9 ± 10.8), KL2 (12.2 ± 11.9), Kl3 (1 ± 12.1), KL4 (16.1 ± 13.0) ODI score: Higher in the KL4 than in the KL1 |