Skip to main content
SpringerLink
Log in

Dislocation rate and its risk factors in total hip arthroplasty with concurrent extensive spinal corrective fusion with pelvic fixation for adult spinal deformity

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Though there are several reports on the high dislocation rates following total hip arthroplasty (THA) before or after spinal surgery, the literature specific to extensive spinal corrective fusion with pelvic fixation for adult spinal deformity is limited. This study determined the rate and risk of hip dislocation after THA and extensive spinal corrective fusion.

Methods

We retrospectively analyzed the data of 23 adults (27 hips) who underwent both extensive spinal corrective fusion with pelvic fixation and THA between 2010 and 2018. Surgery-related characteristics were investigated from medical records, while standing anteroposterior pelvic radiographs and lateral spinal radiographs were used to measure spinal alignment parameters and THA acetabular orientation. Patients were grouped based on the occurrence of dislocation, and the rate and risk of dislocation were compared.

Results

The rate of THA dislocations was extremely high—22% (6 of 27 hips) of patients. All dislocations occurred posteriorly in patients with prior THAs that were performed using the posterior approach. The pelvic tilt was significantly greater in patients with THA dislocations (p = 0.02) than in those without. Cup radiographic anteversion in the supine (p = 0.02) and standing (p = 0.05) positions was significantly smaller in patients with dislocations than in those without.

Conclusion

Total hip arthroplasty concurrent with extensive spinal corrective fusion with pelvic fixation for adult spinal deformity has an extremely high rate of posterior hip dislocation. The posterior surgical approach and prior THA were high risk factors for dislocation. Hip and spine surgeons need focused pre-surgical planning to account for this risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pierrepont J, Hawdon G, Miles BP, Connor BO, Bare J, Walter LR, Marel E, Solomon M, McMahon S, Shimmin AJ (2017) Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. Bone Joint J 99-B:184–191. https://doi.org/10.1302/0301-620X.99B2.BJJ-2016-0098.R1

    Article  CAS  PubMed  Google Scholar 

  2. Taki N, Mitsugi N, Mochida Y, Akamatsu Y, Saito T (2012) Change in pelvic tilt angle 2–4 years after total hip arthroplasty. J Arthroplasty 27:940–944. https://doi.org/10.1016/j.arth.2011.10.003

    Article  PubMed  Google Scholar 

  3. Sato T, Nakashima Y, Matsushita A, Fujii M, Iwamoto Y (2013) Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: a parametric experimental modeling evaluation. Clin Biomech (Bristol, Avon) 28:178–181. https://doi.org/10.1016/j.clinbiomech.2012.12.011

    Article  Google Scholar 

  4. Furuhashi H, Togawa D, Koyama H, Hoshino H, Yasuda T, Matsuyama Y (2017) Repeated posterior dislocation of total hip arthroplasty after spinal corrective long fusion with pelvic fixation. Eur Spine J 26:100–106. https://doi.org/10.1007/s00586-016-4880-y

    Article  PubMed  Google Scholar 

  5. Sing DC, Barry JJ, Aguilar TU, Theologis AA, Patterson JT, Tay BK, Vail TP, Hansen EN (2016) Prior lumbar spinal arthrodesis increases risk of prosthetic-related complication in total hip arthroplasty. J Arthroplasty 31:227–232.e1. https://doi.org/10.1016/j.arth.2016.02.069

    Article  PubMed  Google Scholar 

  6. Malkani AL, Garber AT, Ong KL, Dimar JR, Baykal D, Glassman SD, Cochran AR, Berry DJ (2018) Total hip arthroplasty in patients with previous lumbar fusion surgery: are there more dislocations and revisions? J Arthroplasty 33:1189–1193. https://doi.org/10.1016/j.arth.2017.10.041

    Article  PubMed  Google Scholar 

  7. Esposito CI, Carroll KM, Sculco PK, Padgett DE, Jerabek SA, Mayman DJ (2018) Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation. J Arthroplasty 33:1449–1454. https://doi.org/10.1016/j.arth.2017.12.005

    Article  PubMed  Google Scholar 

  8. 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 32:1635–1640. https://doi.org/10.1016/j.arth.2016.11.029

    Article  PubMed  Google Scholar 

  9. 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 31:2884–2885. https://doi.org/10.1016/j.arth.2016.11.029

    Article  PubMed  Google Scholar 

  10. Eneqvist T, Nemes S, Brisby H, Fritzell P, Garellick G, Rolfson O (2017) Lumbar surgery prior to total hip arthroplasty is associated with worse patient-reported outcomes. Bone Joint J 99-B:759–765. https://doi.org/10.1302/0301-620X.99B6.BJJ-2016-0577.R2

    Article  CAS  PubMed  Google Scholar 

  11. Lum ZC, Coury JG, Cohen JL, Dorr LD (2018) The current knowledge on spinopelvic mobility. J Arthroplasty 33:291–296. https://doi.org/10.1016/j.arth.2017.08.01

    Article  PubMed  Google Scholar 

  12. Stefl M, Lundergan W, Heckmann N, McKnight B, Ike H, Murgai R, Dorr LD (2017) Spinopelvic mobility and acetabular component position for total hip arthroplasty. Bone Joint 99B:37–45. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0415.R1

    Article  Google Scholar 

  13. 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:198–206. https://doi.org/10.1302/0301-620X.101B2.BJJ-2018-0754.R1

    Article  CAS  PubMed  Google Scholar 

  14. Aggarwal VK, Elbuluk A, Dundon J, Herrero C, Hernandez C, Vigdorchik JM, Schwarzkopf R, Iorio R, Lonh WJ (2019) Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Bone Joint J 101-B:646–651. https://doi.org/10.1302/0301-620X.101B6.BJJ-2018-1474.R1

    Article  PubMed  Google Scholar 

  15. Heckman N, McKnight B, Stefl M, Trasolini NA, Ike H, Dorr LD (2018) Late dislocation following total hip arthroplasty: spinopelvic imbalance as a causative factor. J Bone Joint Surg Am 100:1845–1853. https://doi.org/10.2106/JBJS.18.00078

    Article  Google Scholar 

  16. Phan D, Bederman SS, Schwarzkopf R (2015) The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty. Bone Joint J 97-B:1017–1023. https://doi.org/10.1302/0301-620X.97B8.35700

    Article  CAS  PubMed  Google Scholar 

  17. Endo K, Suzuki H, Nishimura H, Tanaka H, Shishido T, Yamamoto K (2012) Sagittal lumbar and pelvic alignment in the standing and sitting positions. J Orthop Sci 17:682–686. https://doi.org/10.1007/s00776-012-0281-1

    Article  PubMed  Google Scholar 

  18. Lazennec JY, Brusson A, Rousseau MA (2013) Lumbar-pelvic-femoral balance on sitting and standing lateral radiographs. Orthop Traumatol Surg Res 99:S87–S103. https://doi.org/10.1016/j.otsr.2012.12.003

    Article  CAS  PubMed  Google Scholar 

  19. Ochi H, Homma Y, Baba T, Nojiri H, Matsumoto M, Kaneko K (2017) Sagittal spinopelvic alignment predicts hip function after total hip arthroplasty. Gait Posture 52:293–300. https://doi.org/10.1016/j.gaitpost.2016.12.010

    Article  PubMed  Google Scholar 

  20. Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833. https://doi.org/10.1097/BRS.0b013e3181a13c08

    Article  PubMed  Google Scholar 

  21. Yamato Y, Hasegawa T, Kobayashi S, Yasuda T, Togawa D, Arima H, Oe S, Iida T, Matsumura A, Hosogane N, Matsumoto M, Matsuyama Y (2016) Calculation of the target lumbar lordosis angle for restoring an optimal pelvic tilt in elderly patients with adult spinal deformity. Spine 41:E211–E217. https://doi.org/10.1097/BRS.0000000000001209

    Article  PubMed  Google Scholar 

  22. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599–E606. https://doi.org/10.1097/BRS.0b013e3181aad219

    Article  Google Scholar 

  23. Weinberg DS, Gebhart JJ, Liu RW (2017) Hip-spine syndrome: a cadaveric analysis between osteoarthritis of the lumbar spine and hip joints. Orthop Traumatol Surg Res 103:651–656. https://doi.org/10.1016/j.otsr.2017.05.010

    Article  CAS  PubMed  Google Scholar 

  24. Boyer B, Philippot R, Geringer J, Farizon F (2012) Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips. Int Orthop 36:511–518. https://doi.org/10.1007/s00264-011-1289-4

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Hiroki Furuhashi, Yu Yamato, Hironobu Hoshino, Yuta Shimizu, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Hiroki Ushirozako & Yukihiro Matsuyama

  2. Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Shizuoka, Japan

    Yu Yamato, Shin Oe & Hiroki Ushirozako

Authors
  1. Hiroki Furuhashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Yamato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hironobu Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuta Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomohiko Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Go Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomohiro Banno
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideyuki Arima
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shin Oe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroki Ushirozako
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yukihiro Matsuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroki Furuhashi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Data availability and material

Applicable.

Ethical approval

Applicable.

Consent for publication

Applicable.

Consent of participate

Applicable.

Ethical standards

This single-center, retrospective study was approved by an appropriate institutional review board, and all experiments in this study complied with the current laws of the country in which they were performed.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Furuhashi, H., Yamato, Y., Hoshino, H. et al. Dislocation rate and its risk factors in total hip arthroplasty with concurrent extensive spinal corrective fusion with pelvic fixation for adult spinal deformity. Eur J Orthop Surg Traumatol 31, 283–290 (2021). https://doi.org/10.1007/s00590-020-02764-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-020-02764-6

Keywords

Search

Navigation