Coexistence of Low Back Pain and Lumbar Kyphosis and the Association With Increased Functional Disability in Knee Osteoarthritis: Results From a Population-Based Cohort.

Abstract

To examine the association of low back pain (LBP) and lumbar kyphosis with functional disabilities and knee symptoms in patients with knee osteoarthritis (OA). We analyzed 586 participants (80.1% female; mean ± SD age 68.8 ± 5.2 years) from the Nagahama Study who were age ≥60 years and had radiographically confirmed knee OA. The Knee Society Knee Scoring System (KSS) was used to assess functional disabilities and knee symptoms. LBP was defined as the presence of any persistent back pain for more than 3 months. Lumbar kyphosis was determined by skin-surface methods using a computer-aided electronic device called the Spinal Mouse. Multiple linear regression analysis was used for assessing the association of LBP and lumbar kyphosis with the KSS scores. Subgroup analyses based on sex were also performed. LBP and lumbar kyphosis were independently associated with a lower KSS function score after adjustment for covariates (mean difference -4.96 [95% confidence interval (95% CI) -7.56, -2.36] points for LBP alone, mean difference -4.47 [95% CI -8.51, -0.43] points for lumbar kyphosis alone, and mean difference -13.86 [95% CI -18.86, -8.86] points for the coexistence of LBP and lumbar kyphosis, respectively). The coexistence of LBP and lumbar kyphosis in women was associated with a lower KSS symptom score (mean difference -4.49 [95% CI -6.42, -2.55] points). These findings suggest that both LBP and lumbar kyphosis are useful clinical signals indicating functional disability and knee symptoms in patients with knee OA.