Knee spine syndrome. paradigm to clinical decision upon patient's pain perception

The concurrent knee-spine degeneration challenged the management dilemma. The research showed 54.6% to 58.1% of individuals with knee osteoarthritis (KOA) has the comorbidity of Low back pain (LBP). This study was conducted to correlate end-stage KOA with complaints of LBP using objective imaging measurements. This is a retrospective study of all end-stage KOA undergoing total knee arthroplasty from 2020 to 2022 with and without LBP complaint upon the objective imaging measurements. The inclusion criteria were all cases without a history of surgery, trauma, or spine or knee joint infection. Low back pain (LBP) pain perception was assessed clinically using the Visual Analog Scale (VAS). The study included 148 patients, with a mean age of 65.75 years, a mean BMI of 25.8, 73.6% being women, 91% having knee varus, and 33.8% exhibiting loss of lumbar lordosis. 114 patients (77%) did not have LBP complaints, although all patients showed spondylolisthesis (grade 1, 2, or 3), and 30% of them lost the lumbar lordosis. Thirty-four patients who had LBP complaints also showed spondylolisthesis, and 64.7% of them lost the lumbar lordosis. Only spondylolisthesis showed a significant correlation with complaints of low back pain (LBP) compared to complaints without low back pain (non-LBP) (p < 0.001). This study highlighted the relationship between KOA and objective radiologic measurement of a patient's pain perception of LBP. All KOA patients showed knee-spine syndrome. These findings emphasize the necessity of knee-spine imaging in the management of KOA and LBP patients.