Which Should Be Prioritised: Knee Surgery or Spine Surgery? An Examination of Treatment Protocols for Patients with Coexisting Pathologies

Abstract

Background: The increasing prevalence of concurrent degenerative knee and lumbar spine disorders presents a challenge for surgical intervention, as the optimal order of treatment remains unclear. This study aims to investigate the influence of knee deformity on surgeons' preferences for treatment order, contributing to informed decision-making in managing these complex cases.

Methods: This retrospective study was conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS) in Patna over one year, involving 50 patients with low back pain and radiculopathy. Participants underwent comprehensive assessments based on predefined inclusion and exclusion criteria, followed by caudal epidural steroid injections.

Results: Responses were obtained from 25 knee arthroplasty and 25 spine surgeons, achieving response rates of 50% for each specialty. The median clinical experience post-training was 26 years for both groups. Recommendations for "TKA first" varied significantly among knee arthroplasty surgeons, with rates of 32%, 76%, 60%, 8%, and 80% across five scenarios (P < 0.001), while spine surgeons recommended "spine surgery first" at rates of 24%, 80%, 52%, 16%, and 76%, also showing significant differences (P < 0.001). Most spine surgeons indicated their decision would remain unchanged if the procedure was a decompression.

Conclusion: This study emphasizes the significant influence of knee deformity on treatment order preferences among knee arthroplasty and spine surgeons, highlighting the need for individualized decision-making in managing patients with concurrent degenerative knee and lumbar spine disorders.