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Outcomes and complications of Total Hip Arthroplasty in patients with a pre-existing pathologic spine-hip relation. A systematic review of the literature

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Abstract

Background

There has been a growing interest in pathologic spine-hip relations (PSHR) in current literature, with the aim of reducing the risk of prosthetic impingement, dislocation, and edge loading in total hip arthroplasty (THA). The primary objective of this review is to determine the effect of different PSHR on primary THA outcomes and complication profile. The secondary objective is to stratify the risk of different subgroups of PSHR patients.

Methods

A systematic review of the literature was performed in accordance with PRISMA guidelines. Randomised controlled trials, comparative cohort studies and case–control studies comparing outcomes and complication rates of primary THA in patients with and without a PSHR (spinal fusion; degenerative spinal conditions determining stiff spine and/or spinal misalignment) were included. The quality of the included studies and the risk of bias were assessed. The revision rate, complications, and clinical and radiological data were analysed. Complications included: aseptic loosening (AL), periprosthetic joint infections (PJI), hip dislocations and periprosthetic fractures (PF).

Results

Fifteen articles were included with 3.306.342 THAs. The mean follow-up (FU) was 31.4 ± 21.7 months. The population was divided into three subgroups: spinal fusion patients (48.315 THAs); non-fused patients with spinal stiffness (106.110 THAs); non-fused patients with normal spines (3.151.917 THAs). A statistically significant risk stratification was observed about dislocation rate (5.98 ± 6.9% SF, 3.0 ± 1.9% non-SF Stiff and 2.26 ± 1.4% non-SF; p = 0.028). Similarly, about THA revision rate, a statistically significant risk stratification was also observed (7.3 ± 6.8% SF, 6.4 ± 3.1% non-SF Stiff and 2.7 ± 1.7% non-SF; p = 0.020). No statistically significant difference was observed when analysing AL, PJI and PF.

Conclusion

A statistically significant risk stratification of dislocation and revision rate was observed in the different PHSR, as theorised by the Bordeaux classification. Fused patients present a higher risk, degenerated and/or stiff spine an intermediate risk and mobile spines a lower risk profile. A standardised approach to THA candidate patients must consider the possible PSHR to improve clinical outcomes and reduce adverse events of THA.

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Acknowledgements

The authors would like to thank Dr Beatrice Dozin for data statistical analysis and Viviana Quarto for her English language corrections.

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Authors and Affiliations

  1. IRCCS Policlinico San Martino, Clinica Ortopedica, DISC, Genova, Italy

    Andrea Zanirato, Emanuele Quarto, Chiara Ursino, Emilio Ferrari & Matteo Formica

  2. IRCCS Istituto Ortopedico Galeazzi, Milano, Italy

    Riccardo D’Ambrosi & Ursino Nicola

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  1. Andrea Zanirato
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  2. Emanuele Quarto
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  3. Chiara Ursino
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  4. Emilio Ferrari
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Contributions

Andrea Zanirato and Emanuele Quarto, first draft, data analysis; Chiara Ursino and Emilio Ferrari, literature review, article selection and data collection; Riccardo D’Ambrosi, methodology; Nicola Ursino and Matteo Formica, final draft.

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Correspondence to Emanuele Quarto.

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Zanirato, A., Quarto, E., Ursino, C. et al. Outcomes and complications of Total Hip Arthroplasty in patients with a pre-existing pathologic spine-hip relation. A systematic review of the literature. International Orthopaedics (SICOT) 48, 931–943 (2024). https://doi.org/10.1007/s00264-023-06067-3

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