Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review
- 61 Downloads
Hip and spine pathology can alter the biomechanics of spino-pelvic mobility. Lumbar spine fusions can reduce the mobility of the lumbar spine and therefore result in compensatory femoral motion, contributing towards dislocations of THA.
This meta-analysis aims to determine the effect of pre-existing spine fusions on THA outcomes, and complication profile including hip dislocations, all-cause revisions and all complications.
A multi-database search was performed according to PRISMA guidelines. All studies that compared patients who underwent THA with and without prior SF were included in the analysis.
Ten studies were included in this review, consisting of 28,396 SF THA patients and 1,550,291 non-SF THA patients. There were statistically significant higher rates of hip dislocation (OR 2.20, 95% CI 1.71–2.85, p < 0.001), all-cause revision (OR 3.43, 95% CI 1.96–6.00, p < 0.001) and all complications (OR 2.83, 95% CI 1.28–6.24, p = 0.01) in SF than in non-SF THA patients. When registry data were excluded, these rates were approximately doubled. Subgroup analysis of revisions for dislocations was not statistically significant (OR 5.28, 95% CI 0.76–36.87, p = 0.09). While no meta-analysis was performed on clinical outcomes due to heterogeneous parameter reporting, individual studies reported significantly poorer outcomes in SF patients than in non-SF patients.
THA patients with SF are at higher risks of hip dislocations, all-cause revisions and all complications, which may adversely affect patient-reported outcomes. Surgeons should be aware of these risks and appropriately plan to account for altered spino-pelvic biomechanics, in order to reduce the risks of hip dislocations and other complications.
Level of evidence
II (Meta-analysis of non-homogeneous studies).
KeywordsHip dislocation Complications Total hip arthroplasty Total hip replacement Spinal fusion
JRO contributed to idea conception, literature search, data collection, statistics, manuscript writing and editing. MN contributed to idea conception, manuscript writing and editing. JO contributed to literature search, data collection, statistics, figures and tables, and manuscript writing. KP contributed to statistics, figures and manuscript writing. AA, SB and RH contributed to manuscript writing and editing.
Compliance with ethical standards
Conflict of interest
Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
- 3.Archbold HA, Mockford B, Molloy D, McConway J, Ogonda L, Beverland D (2006) The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br 88(7):883–886PubMedCrossRefPubMedCentralGoogle Scholar
- 13.Dargel J, Oppermann J, Brüggemann G-P, Eysel P (2014) Dislocation following total hip replacement. Deutsch Arztebl Int 111(51–52):884–890Google Scholar
- 16.Fessy MH, Putman S, Viste A, Isida R, Ramdane N, Ferreira A et al (2017) What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case–control study of 128 unstable and 438 stable hips. Orthop Traumatol Surg Res 103(5):663–668PubMedCrossRefPubMedCentralGoogle Scholar
- 17.Gliklich RE, Dreyer NA, Leavy MB (2014) 201 Registries for evaluating patient outcomes: a user’s guide, chapter 13, 3rd edn. Agency for Healthcare Research and Quality (US), RockvilleGoogle Scholar
- 33.Mannion AF, Impellizzeri FM, Leunig M, Jeszenszy D, Becker HJ, Haschtmann D et al (2018) EUROSPINE 2017 FULL PAPER AWARD: time to remove our rose-tinted spectacles: a candid appraisal of the relative success of surgery in over 4500 patients with degenerative disorders of the lumbar spine, hip or knee. Eur Spine J 27(4):778–788PubMedCrossRefPubMedCentralGoogle Scholar
- 34.McLawhorn AS, Sculco PK, Weeks KD, Nam D, Mayman DJ (2016) Targeting a new safe zone: a step in the development of patient-specific component positioning for total hip arthroplasty. Am J Orthop (Belle Mead NJ) 44(6):270–276Google Scholar
- 39.Noordin S, Lakdawala R, Masri BA (2012) Primary total hip arthroplasty: staying out of trouble intraoperatively. Ann Med Surg 2018(29):30–33Google Scholar
- 43.Phan K, Nazareth A, Hussain AK, Dmytriw AA, Nambiar M, Nguyen D et al (2018) Relationship between sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique. Eur Spine J 27(8):1981–1991PubMedCrossRefPubMedCentralGoogle Scholar
- 44.Pierrepont J, Stambouzou C, Miles B, O’Connor P, Ellis A, Molnar R et al (2016) Patient-specific component alignment in total hip arthroplasty. Reconstr Rev 6(4):7Google Scholar