Spinal flexibility is an important factor for improvement in spinal and knee alignment after total knee arthroplasty: Evaluation using a whole body EOS system

The purposes of this study were (1) to evaluate the relationship between lumbosacral flexibility and the effects of total knee arthroplasty (TKA) on whole‐body alignment; and (2) to determine the prerequisites of the adjacent joints for successful TKA. A total of 116 patients (156 cases) who had whole‐body X‐ray and flexion‐extension lumbar radiograph available were enrolled. For the sagittal alignment evaluation, hip–knee–ankle (HKA) angle, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and C7 plumb line‐sacrum distance (SVA) were evaluated on the whole‐body radiographs. Lumbar flexibility (LF) was evaluated using the flexion‐extension lumbar radiographs, and pelvic flexibility (PF) was evaluated using the pelvic incidence (PI). The disparities in the knee joint between postoperative passive motion and weight-bearing posture were assessed. LF was significantly correlated with ΔLL and ΔSVA (LL: p = 0.039, SVA: p = 0.040; Pearson correlation coefficient (PCC): −0.206 and 0.205, respectively). There were correlations between PF and ΔSS (p < 0.001, PCC: −0.362), and between the disparity and LF (p = 0.005, PCC = −0.275). Linear regression analysis demonstrated that LF was significantly associated with the presence of disparity (p = 0.005, β = −0.205). LF is an important factor for improved spinal and lower limb alignment after TKA. Additionally, reduced LF may result in knee joint disparity between passive extension and standing extension status. Therefore, surgeons should consider spinopelvic alignment, including lower limb alignment preoperatively, to be able to predict possible changes in whole‐body alignment following TKA.