Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review

  • James Randolph OnggoEmail author
  • Mithun Nambiar
  • Jason Derry Onggo
  • Kevin Phan
  • Anuruban Ambikaipalan
  • Sina Babazadeh
  • Raphael Hau
Review Article



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).

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Hip dislocation Complications Total hip arthroplasty Total hip replacement Spinal fusion 


Author contributions

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.

Supplementary material

586_2019_6201_MOESM1_ESM.pptx (253 kb)
Supplementary material 1 (PPTX 253 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryBox Hill HospitalBox HillAustralia
  2. 2.Department of SurgeryThe University of MelbourneParkvilleAustralia
  3. 3.School of MedicineFlinders UniversityAdelaideAustralia
  4. 4.NeuroSpine Research GroupSydneyAustralia
  5. 5.Department of Orthopaedic SurgerySt Vincent’s HospitalEast MelbourneAustralia
  6. 6.Epworth Eastern HospitalBox HillAustralia

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