Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Co-Morbid Pain in Hips, Low Back, and Non-Operative Knee Associated with Physical Function before and after TKR.

Franklin2,  Patricia D., Li2,  Wenjun, Ayers2,  David C., Oatis1,  Carol A.

Arcadia University, Glenside, PA
Univ of MA Med Schl, Worcester, MA


Older age, female gender, obesity, and poor emotional health are associated with poorer function before and after total knee replacement (TKR). In addition, medical co-morbidities are related to peri-operative adverse events. However, no research has documented the role of co-morbid pain in the low back, hips, and the non-operative knee on physical function before and after TKR. We evaluated the association of co-morbid low back, hip, and bi-lateral knee pain with function in TKR patients.


A prospective cohort of 130 consecutive, primary, unilateral TKR patients enrolled in a clinical trial reported demographic, pain, and function data before and at 6 months after TKR. Descriptive and multivariate analyses evaluated the associations among age, gender, BMI, emotional health (SF36, MCS), WOMAC pain score in both hips and both knees, and Oswestry low back pain and associations with (1) pre-op function (SF36, PCS) and (2) pre-post functional gain.


Patients were 60% women with mean age=65, BMI=32.6, pre-TKR PCS=32.7. Before TKR, 52% reported mild or no pain in the non-operative knee, hips, and low back. Twenty (20) percent reported moderate/severe pain in one other joint or back, 13% in two locations, and 10% in 3 or 4 locations. Women reported moderate/severe pain more than men in the non-operative knee (34.5% vs. 11%); ipsilateral hip (28% vs. 15%); and low back (33% vs. 20%). After adjusting for age, gender, BMI, and MCS, greater pain in the surgical knee (p< 0.000), contralateral hip (p < 0.074), and low back (p <0.028) was associated with poorer function in TKR patients (r2=.39).


In addition to pain in the surgical knee, co-morbid pain in the non-operative knee, hips, and low back explain much variation in peri-TKR function. Women report more non-operative joint pain than men at the time of TKR. These data suggest a need for a musculoskeletal co-morbidity score to assess total pain burden when evaluating TKR patient function before and after surgery.

To cite this abstract, please use the following information:
Franklin, Patricia D., Li, Wenjun, Ayers, David C., Oatis, Carol A.; Co-Morbid Pain in Hips, Low Back, and Non-Operative Knee Associated with Physical Function before and after TKR. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2136
DOI: 10.1002/art.29900

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