Timing of Lumbar Spinal Fusion Affects Total Hip Arthroplasty Outcomes

Abstract

Background:Many patients are affected by concurrent disease of the hip and spine, undergoing both total hip arthroplasty (THA) and lumbar spinal fusion (LSF). Recent literature demonstrates increased prosthetic dislocation rates in patients with THA done after LSF. Evidence is lacking on which surgery to do first to minimize complications. The purpose of this study was to evaluate the effect of timing between the two procedures on postoperative outcomes.Methods:We queried the Medicare standard analytics files between 2005 and 2014. Four groups were identified and matched by age and sex: THA with previous LSF, LSF with previous THA, THA with spine pathology without fusion, and THA without spine pathology. Revision THA or LSF and bilateral THA were excluded. Comorbidities and Charlson Comorbidity Index were identified. Postoperative complications at 90 days and 2 years were calculated after the most recent surgery. Four-way chi-squared and standard descriptive statistics were calculated.Results:Thirteen thousand one hundred two patients had THA after LSF, 10,482 patients had LSF after THA, 104,820 had THA with spine pathology, and 492,654 had THA without spine pathology. There was no difference in the Charlson Comorbidity Index score between the THA after LSF and LSF after THA groups. There was a statistically significant difference in THA dislocation rate, with LSF after THA at 1.7%, THA without spine pathology at 2.3%, THA with spine pathology at 3.3%, and THA after LSF at 4.6%. There was a statistically significant difference in THA revision rate, with THA without spine pathology at 3.3%, LSF after THA at 3.7%, THA with spine pathology at 4.2%, and THA after LSF at 5.7%.Conclusion:LSF after THA is associated with a reduced dislocation rate compared with THA after LSF. Reasons may include decreasing pelvic mobility in a stable, well-healed THA or early postoperative spine precautions after LSF restricting positions of dislocation.

Stability in Direct Lateral vs Direct Anterior Total Hip Arthroplasty in the Context of Lumbar Spinal Fusion

“…Malkani et al 39 compared patients who received an LSF before a THA with those who underwent an LSF after THA from a 10-year Medicare inpatient claims data set, noting that patients who underwent a THA after LSF were at a 106% increased risk of sustaining a dislocation when compared with patients who received this combination of surgeries in the opposite order. Similarly, Bala et al 40 A variety of limitations make the findings of this study less translatable to the general population, most importantly, the retrospective nature of the study and hence a predisposition to reporting bias. Despite the extensive and exhaustive search criterion that was conducted to identify every post-THA dislocations in this cohort, patients who sustained a prosthetic dislocation at an outside institution may not all have been reported.…”

Spinopelvic Alignment and Its Use in Total Hip Replacement Preoperative Planning—Decision Making Guide and Literature Review

“…Another approach may cause risk to THR stability [38]. As noted in the literature, the dislocation rate in patients with lumbar spine fusion (LSF) after THR is 1.7%, in patients with THR without spine pathology is 2.3%, in patients with THR with spine pathology at 3.3%, and in patients with THR after LSF is 4.6% [39]. Other works give more information regarding how not only the timing of the operations but also the range of lumbar fusions can affect the dislocation rate.…”

Surgical implications of the hip-spine relationship in total hip arthroplasty

“… 42 , 44 When patients are affected by hip and spine symptoms the severity of the symptoms and limitations in activities of daily living guides the treatment into which district has the priority. 37 , 42 , 43 , 45-47 …”

“…42,44 When patients are affected by hip and spine symptoms the severity of the symptoms and limitations in activities of daily living guides the treatment into which district has the priority. 37,42,43,[45][46][47] Sultan et al, 41 proposed an algorithmic approach in the setting of concomitant lumbar spine disease and advanced hiposteoarthritis (OA) when both require surgical management. The first evaluation is based on the presence of hip flexion contracture; if present, THA should be performed first in order to eliminate these contractures that can contribute to the sagittal imbalance followed by a re-evaluation of the spine balance.…”