Concurrent lumbar degenerative disease is independently associated with chronic post-surgical pain after total knee arthroplasty for knee osteoarthritis: a retrospective study

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OBJECTIVE: Chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA) remains a significant clinical challenge. This study aimed to investigate the association between concurrent lumbar degenerative disease (LDD) and CPSP after TKA for knee osteoarthritis (KOA). METHODS: A total of 348 KOA patients undergoing first unilateral TKA (June 2023-June 2025) were enrolled and stratified into LDD (n = 167) and non-LDD (n = 181) groups. CPSP incidence, pain severity, and postoperative knee function were compared. Logistic regression models were constructed to identify influencing factors for CPSP after TKA. RESULTS: At 6 months postoperatively, both groups showed significant improvements in knee function, mobility, and pain (all P < 0.05). Compared with the non-LDD group, the LDD group exhibited lower knee society scores, reduced knee range of motion, a shorter 6-minute walk distance, a longer timed up and go test time, higher visual analogue scale (VAS) scores for pain at rest and during activity, a higher rate of non-steroidal anti-inflammatory drug use, and a higher incidence of CPSP (all P < 0.05). Depression/anxiety history, preoperative VAS scores, and LDD were independently associated with CPSP after TKA in patients with KOA (all P < 0.05). Among patients with KOA with concurrent LDD, depression/anxiety history, preoperative VAS scores, and preoperative radicular symptoms were independently associated with CPSP after TKA (all P < 0.05). CONCLUSION: LDD is independently associated with CPSP after TKA. In patients with KOA with concurrent LDD, preoperative radicular symptoms, depression/anxiety history, and intense preoperative pain further increase CPSP risk.

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