Lower Extremity Osteoarthritis: A Risk Factor for Mental Health Disorders, Prolonged Opioid Use, and Increased Resource Utilization After Single-Level Lumbar Spinal Fusion

Abstract

Introduction: Few studies have examined the effect of hip or knee osteoarthritis, together described as lower extremity osteoarthritis (LEOA) on patient outcomes after lumbar fusion. The purpose of this study was to evaluate the effect of LEOA on postoperative outcomes and resource utilization in patients undergoing single-level lumbar fusion. Methods: Using a national deidentified database, TriNetX, a retrospective observational study of 17,289 patients undergoing single-level lumbar fusion with or without a history of LEOA before September 1, 2019, was conducted. The no-LEOA and LEOA groups were propensity score matched, and 2-year outcomes were compared using univariate statistical analysis. Results: After propensity score matching, 2289 patients with no differences in demographics or comorbidities remained in each group. No differences in the rate of repeat lumbar surgery were observed between groups (all P > 0.30). In comparison with patients with no LEOA, patients with LEOA experienced higher rates of overall and new onset depression or anxiety, prolonged opioid use, hospitalizations, emergency department visits, and ambulatory visits over the 2-year postoperative period (all P < 0.02). Conclusion: Patients with LEOA undergoing single-level lumbar fusion surgery are at higher risk for suboptimal outcomes and increased resource utilization postoperatively. This complex population may benefit from additional individualized education and multidisciplinary management.

Effect of Lower Extremity Osteoarthritis on Outcomes of Lumbar Decompression

“… 10 , 13 - 15 The effects of total knee arthroplasty (TKA) and nonsurgically managed LEOA on lumbar fusion outcomes have been evaluated with less frequency. 16 - 18 It is appropriate that most studies evaluating the spinopelvic–lower extremity relationship have focused on fusions, given the notable changes in sagittal alignment and spinopelvic mobility produced by the procedure. 10 However, the kinematic relationship between elements of the chain is also altered by isolated decompression procedures, which are highly effective in the treatment of LSS.…”