Abstract
Purpose
This study aimed to compare the complication rates and functional outcomes between patients with and without a history of spinal fusion undergoing THA.
Methods
A systematic search was conducted across PubMed, EMBASE, Scopus, and Cochrane databases. Studies that compared adults with and without a history of spinal fusion after primary THA were included. The methodological quality of the studies was evaluated using MINORS criteria. Meta-analyses were performed utilizing mean differences (MD), standardized mean differences (SMD), and odds ratios (OR), along with 95% confidence intervals (CI).
Results
Seventeen studies involving 1,789,356 patients (31,786 in the SF group and 1,757,570 in the Non-SF group) were analyzed. The spinal fusion group exhibited significantly higher rates of dislocation (OR 2.50, 95% CI 1.78–3.52), periprosthetic fracture (OR 1.96, 95% CI 1.39–2.77), overall complications (OR 1.73, 95% CI 1.10–2.71), and revision rates (OR 1.86, 95% CI 1.74–1.99). Furthermore, within the first three months, there was an increased risk of dislocation (OR 4.38, 95% CI 1.36–14.14) and revisions (OR 3.87, 95% CI 1.63–9.18). Longer spinal fusions were significantly associated with a higher risk of dislocations (OR 0.62, 95% CI 0.53–0.71). Additionally, prior spinal fusion was linked to higher levels of pain (SMD 0.11, 95% CI 0.02–0.19) and poorer functional outcomes (MD − 0.09, 95% CI − 0.18 to − 0.00).
Conclusions
Patients with a history of spinal fusion undergoing THA exhibit increased complication rates, higher levels of pain, and greater functional limitations than those without prior fusion. These findings have significant clinical implications for optimizing perioperative care in high-risk patient populations.
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References
MaraditKremers H, Larson DR, Crowson CS, Kremers WK, Washington RE et al (2015) Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 97(17):1386–1397. https://doi.org/10.2106/JBJS.N.01141
Agarwal N, To K, Khan W (2021) Cost effectiveness analyses of total hip arthroplasty for hip osteoarthritis: a PRISMA systematic review. Int J Clin Pract 75(2):e13806. https://doi.org/10.1111/ijcp.13806
Safaee MM, Ames CP, Smith JS (2020) Epidemiology and socioeconomic trends in adult spinal deformity care. Neurosurgery 87(1):25–32. https://doi.org/10.1093/neuros/nyz454
Johnson WC, Seifi A (2018) Trends of the neurosurgical economy in the United States. J Clin Neurosci 53:20–26. https://doi.org/10.1016/j.jocn.2018.04.041
Devin CJ, McCullough KA, Morris BJ, Yates AJ, Kang JD (2012) Hip-spine syndrome. J Am Acad Orthop Surg 20(7):434–442. https://doi.org/10.5435/JAAOS-20-07-434
Fogel GR, Esses SI (2003) Hip spine syndrome: management of coexisting radiculopathy and arthritis of the lower extremity. Spine J 3(3):238–241. https://doi.org/10.1016/s1529-9430(02)00453-9
Stupar M, Côté P, French MR, Hawker GA (2010) The association between low back pain and osteoarthritis of the hip and knee: a population-based cohort study. J Manipulative Physiol Ther 33(5):349–354. https://doi.org/10.1016/j.jmpt.2010.05.008
Weng W, Wu H, Wu M, Zhu Y, Qiu Y, Wang W (2016) The effect of total hip arthroplasty on sagittal spinal-pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis. Eur Spine J 25(11):3608–3614. https://doi.org/10.1007/s00586-016-4444-1
Sing DC, Barry JJ, Aguilar TU, Theologis AA, Patterson JT, Tay BK et al (2016) Prior lumbar spinal arthrodesis increases risk of prosthetic-related complication in total hip arthroplasty. J Arthroplasty 31(9 Suppl):227-232.e1. https://doi.org/10.1016/j.arth.2016.02.069
Malkani AL, Garber AT, Ong KL, Dimar JR, Baykal D, Glassman SD et al (2018) Total hip arthroplasty in patients with previous lumbar fusion surgery: are there more dislocations and revisions? J Arthroplasty 33(4):1189–1193. https://doi.org/10.1016/j.arth.2017.10.041
Hinman AD, Inacio MCS, Prentice HA, Kuo CC, Khatod M, Guppy KH et al (2020) Lumbar spine fusion patients see similar improvements in physical activity level to non-spine fusion patients following total hip arthroplasty. J Arthroplasty 35(2):451–456. https://doi.org/10.1016/j.arth.2019.08.053
Onggo JR, Nambiar M, Onggo JD, Phan K, Ambikaipalan A, Babazadeh S et al (2020) Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review. Eur Spine J 29(2):282–294. https://doi.org/10.1007/s00586-019-06201-z
Epstein AM (2009) Revisiting readmissions–changing the incentives for shared accountability. N Engl J Med 360(14):1457–1459. https://doi.org/10.1056/NEJMe0901006
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x
Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ et al (2019) Cochrane handbook for systematic reviews of interventions. Wiley, Hoboken
Barry JJ, Sing DC, Vail TP, Hansen EN (2017) Early outcomes of primary total hip arthroplasty after prior lumbar spinal fusion. J Arthroplasty 32(2):470–474. https://doi.org/10.1016/j.arth.2016.07.019
Bedard NA, Martin CT, Slaven SE, Pugely AJ, Mendoza-Lattes SA, Callaghan JJ (2016) Abnormally high dislocation rates of total hip arthroplasty after spinal deformity surgery. J Arthroplasty 31(12):2884–2885. https://doi.org/10.1016/j.arth.2016.07.049
Buckland AJ, Puvanesarajah V, Vigdorchik J, Schwarzkopf R, Jain A, Klineberg EO et al (2017) Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion. Bone Joint J 99-B(5):585–591. https://doi.org/10.1302/0301-620X.99B5.BJJ-2016-0657.R1
Di Martino A, Bordini B, Ancarani C, Viceconti M, Faldini C (2021) Does total hip arthroplasty have a higher risk of failure in patients who undergo lumbar spinal fusion? Bone Joint J 103-B(3):486–491. https://doi.org/10.1302/0301-620X.103B3.BJJ-2020-1209.R1
Di Martino A, Bordini B, Geraci G, Ancarani C, D’Agostino C, Brunello M et al (2023) Impact of previous lumbar spine surgery on total hip arthroplasty and vice versa: how long should we be concerned about mechanical failure? Eur Spine J 32(9):2949–2958. https://doi.org/10.1007/s00586-023-07866-3
Diebo BG, Beyer GA, Grieco PW, Liu S, Day LM, Abraham R et al (2018) Complications in patients undergoing spinal fusion after THA. Clin Orthop Relat Res 476(2):412–417. https://doi.org/10.1007/s11999.0000000000000009
Eneqvist T, Bülow E, Nemes S, Brisby H, Garellick G, Fritzell P et al (2018) Patients with a previous total hip replacement experience less reduction of back pain following lumbar back surgery. J Orthop Res 36(9):2484–2490. https://doi.org/10.1002/jor.24018
Klemt C, Padmanabha A, Tirumala V, Walker P, Smith EJ, Kwon YM (2021) Lumbar spine fusion before revision total hip arthroplasty is associated with increased dislocation rates. J Am Acad Orthop Surg 29(17):e860–e868. https://doi.org/10.5435/JAAOS-D-20-00824
Loh JLM, Jiang L, Chong HC, Yeo SJ, Lo NN (2017) Effect of spinal fusion surgery on total hip arthroplasty outcomes: a matched comparison study. J Arthroplasty 32(8):2457–2461. https://doi.org/10.1016/j.arth.2017.03.031
Perfetti DC, Schwarzkopf R, Buckland AJ, Paulino CB, Vigdorchik JM (2017) Prosthetic dislocation and revision after primary total hip arthroplasty in lumbar fusion patients: a propensity score matched-pair analysis. J Arthroplasty 32(5):1635-1640.e1. https://doi.org/10.1016/j.arth.2016.11.029
Pheasant MS, Coulter JL, Wallace C, Kropp Lopez AK, DelSole EM, Mercuri JJ (2021) Lumbar spine fusion and symptoms of leg length discrepancy after hip arthroplasty. J Arthroplasty 36(9):3241-3247.e1. https://doi.org/10.1016/j.arth.2021.05.006
Salib CG, Reina N, Perry KI, Taunton MJ, Berry DJ, Abdel MP (2019) Lumbar fusion involving the sacrum increases dislocation risk in primary total hip arthroplasty. Bone Joint J 101-B(2):198–206. https://doi.org/10.1302/0301-620X.101B2.BJJ-2018-0754.R1
Welling S, Smith S, Yoo J, Philipp T, Mildren M, Kagan R (2023) Is timing of total hip arthroplasty and lumbar spine fusion associated with risk of hip dislocation? Arthroplast Today 23:101202. https://doi.org/10.1016/j.artd.2023.101202
York PJ, McGee AW Jr, Dean CS, Hellwinkel JE, Kleck CJ, Dayton MR et al (2018) The relationship of pelvic incidence to post-operative total hip arthroplasty dislocation in patients with lumbar fusion. Int Orthop 42(10):2301–2306. https://doi.org/10.1007/s00264-018-3955-2
Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(6 Suppl):190S-194S. https://doi.org/10.1016/j.spinee.2004.07.007
Oommen AT, Hariharan TD, Chandy VJ, Poonnoose PM, Arun Shankar A, Kuruvilla RS et al (2021) Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis. World J Orthop 12(12):970–982. https://doi.org/10.5312/wjo.v12.i12.970
Bishi H, Smith JBV, Asopa V, Field RE, Wang C, Sochart DH (2022) Comparison of the accuracy of 2D and 3D templating methods for planning primary total hip replacement: a systematic review and meta-analysis. EFORT Open Rev 7(1):70–83. https://doi.org/10.1530/EOR-21-0060
Han PF, Chen CL, Zhang ZL, Han YC, Wei L, Li PC et al (2019) Robotics-assisted versus conventional manual approaches for total hip arthroplasty: a systematic review and meta-analysis of comparative studies. Int J Med Robot 15(3):e1990. https://doi.org/10.1002/rcs.1990
Chai W, Guo RW, Puah KL, Jerabek S, Chen JY, Tang PF (2020) Use of robotic-arm assisted technique in complex primary total hip arthroplasty. Orthop Surg 12(2):686–691. https://doi.org/10.1111/os.12659
Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220
Centers for Medicare & Medicaid Services (CMS), HHS (2015) Medicare program; comprehensive care for joint replacement payment model for acute care hospitals furnishing lower extremity joint replacement services. Final Rule Fed Regist 80(226):73273–554
Arnold JB, Walters JL, Ferrar KE (2016) Does physical activity increase after total hip or knee arthroplasty for osteoarthritis? A systematic review. J Orthop Sports Phys Ther 46:431–442. https://doi.org/10.2519/jospt.2016.6449
Jain N, Phillips FM, Weaver T, Khan SN (2018) Preoperative chronic opioid therapy: a risk factor for complications, readmission, continued opioid use and increased costs after one- and two-level posterior lumbar fusion. Spine (Phila Pa 1976) 43:1331–1338. https://doi.org/10.1097/BRS.0000000000002609
Sadler SG, Spink MJ, Ho A, De Jonge XJ, Chuter VH (2017) Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskelet Disord 18(1):179. https://doi.org/10.1186/s12891-017-1534-0
Jain D, Bendich I, Nguyen LL, Nguyen LL, Lewis CG, Huddleston JI et al (2017) Do patient expectations influence patient-reported outcomes and satisfaction in total hip arthroplasty? A prospective. Multicenter Study J Arthroplasty 32(11):3322–3327. https://doi.org/10.1016/j.arth.2017.06.017
Desai AS, Dramis A, Board TN (2013) Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med 6:336–341. https://doi.org/10.1007/s12178-013-9180-0
Resende RA, Kirkwood RN, Deluzio KJ, Cabral S, Fonseca ST (2016) Biomechanical strategies implemented to compensate for mild leg length discrepancy during gait. Gait Posture 46:147–153. https://doi.org/10.1016/j.gaitpost.2016.03.012
Hasegawa K, Dubousset JF (2022) Cone of economy with the chain of balance-historical perspective and proof of concept. Spine Surg Relat Res 6(4):337–349. https://doi.org/10.22603/ssrr.2022-0038
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Soler, F., Murcia, A. & Mariscal, G. Impact of prior spinal fusion surgery on complications and functional outcomes following total hip arthroplasty: an updated systematic review and meta-analysis. Eur Spine J 33, 1001–1012 (2024). https://doi.org/10.1007/s00586-024-08133-9
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DOI: https://doi.org/10.1007/s00586-024-08133-9