Association of lower back pain(LBP) and knee osteoarthritis(KOA); a systematic review

Abstract

Abstract Background: Osteoarthritis and lower back pain (LBP) are among most common health problems worldwide leading pain and disability. The purpose of this study was to systematically review the evidence to find any association between knee osteoarthritis (KOA) and LBP.Methods: The databases of Scopus, Medline and EMBASE were searched from inception to 22.02.2021. Any study published in English assessing live humans over 18 years with KOA and LBP were eligible to be included. Data were independently assessed by two researchers. Data were extracted based on the participants, outcomes related to knee, outcomes related to lumbar spine, association between LBP and KOA and study design approach. Results: Of 8620 titles and abstracts, duplicates were removed and 6219 were screened. Altogether 87 full texts were screened and 12 were eligible for the final inclusion.Conclusions: There were some biomechanical and clinical associations observed between LBP and KOA. High pelvic incidence is a risk factor for development of spondylolisthesis and KOA. Development and progression of KOA in patients with degenerative spondylolisthesis may be induced by significantly greater mismatches of lumbo-pelvic sagittal alignment. Elderly patients with degenerative lumbar spondylolisthesis and comorbid severe KOA reported a different pelvic morphology, increased sagittal malalignment with a lack of lumbar lordosis due to double-level listhesis, and greater knee flexion contracture than in patients with no to mild and moderate KOA. Knee pain intensity was higher in KOA when presents with LBP. People with concurrent LBP and KOA have reported poor function with more disability. Assessing both back and knee joints should be considered when treating KOA and vice-versa, to clinically manage, and to prevent further progression. High quality RCTs with a long-term follow-up should be designed to assess the exercise programs consist of both lumbar and knee exercises for these patients. Systematic review registration: PROSPERO (CRD42022238571)