膝关节置换术(TKA/UKA)是治疗重度膝关节骨性关节炎(KOA)的有效手段，但术后仍有高达20%的不满意率。近年来，脊柱–骨盆矢状面平衡参数与膝关节置换术预后的关联逐渐成为研究热点。研究表明，脊柱–骨盆矢状面失衡通过脊柱过度伸展、骨盆后倾和膝关节屈曲等代偿机制增加膝关节负荷，不仅加速KOA进展，而且与术后僵硬及患者满意度下降显著相关。同时，全膝关节置换术后也会对脊柱–骨盆矢状面平衡产生影响。未来需结合多模态评估、精准手术技术及跨学科合作，推动“脊柱–膝关节一体化”诊疗策略，以实现从局部重建到全身力线优化的目标。本综述系统分析了脊柱–骨盆矢状面参数的生物力学定义、代偿机制及其与KOA的病理生理作用，并探讨其在膝关节置换术中的临床价值。Knee arthroplasty (TKA/UKA) is an effective treatment for severe knee osteoarthritis (KOA), but the dissatisfaction rate after surgery can be as high as 20%. In recent years, the association between spinal-pelvic sagittal balance parameters and the prognosis of TKA has gradually become a research hotspot. Studies have shown that spinal-pelvic sagittal imbalance increases the load on the knee joint through compensatory mechanisms such as excessive spinal extension, posterior pelvic tilt, and knee flexion, which not only accelerates the progression of KOA but is also significantly associated with postoperative stiffness and decreased patient satisfaction. At the same time, total knee arthroplasty can also affect the spinal-pelvic sagittal balance. In the future, it is necessary to combine multi-modal assessment, precise surgical techniques, and interdisciplinary collaboration to promote an integrated “spine-knee” diagnostic and treatment strategy, with the goal of transitioning from local reconstruction to optimization of the overall mechanical alignment. This review systematically analyzes the biomechanical definitions of spinal-pelvic sagittal parameters, their compensatory mechanisms, and their pathophysiological roles in KOA, and discusses their clinical value in knee arthroplasty.