Patients Who Undergo Primary Lumbar Spine Fusion After Recent but Not Remote Total Hip Arthroplasty Are at Increased Risk for Complications, Revision Surgery, and Prolonged Opioid Use

AbstractDislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion have been reported as high as 20%. Few studies exist specifically for lumbar spine degenerative joint disease (DJD) and its relationship to THA instability. There were two study objectives: (1) report the incidence of lumbar spine DJD and previous lumbar spine fusion and (2) evaluate the relationship of these two conditions and other potential risk factors to postoperative dislocation after THA. We retrospectively reviewed 818 consecutive THAs performed by a single surgeon utilizing a posterior approach. Comprehensive medical chart and radiographic review was performed to identify patients with lumbar spine DJD and lumbar spine fusion. Radiographic measurements, patient factors, surgical factors, and incidences of dislocation also were recorded. Eight hundred and twelve THAs were analyzed. There were 10 dislocations (1.2%, 10/812). Lumbar spine DJD and previous lumbar spine fusion occurred in 33.4% (271/812) and 5.9% (48/812) of patients, respectively. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation using a Firth penalized maximum likelihood estimation specifically for rare events (area under receiver-operator characteristic curve = 0.91, 95% confidence interval 0.86, 0.96). Interestingly, only 2 of 10 dislocations had a previous lumbar spine fusion. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation, while lumbar spine fusion was largely unrelated. This study used data available to most practicing surgeons and provides useful information for counseling patients preoperatively.

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Lumbar Spine Fusion Patients See Similar Improvements in Physical Activity Level to Non-Spine Fusion Patients Following Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.08.053 ◽

2020 ◽

Vol 35 (2) ◽

pp. 451-456

Author(s):

Adrian D. Hinman ◽

Maria C.S. Inacio ◽

Heather A. Prentice ◽

Calvin C. Kuo ◽

Monti Khatod ◽

...

Keyword(s):

Physical Activity ◽

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Physical Activity Level ◽

Spine Fusion ◽

Activity Level ◽

Total Hip ◽

Lumbar Spine Fusion

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Time to Dislocation Analysis of Lumbar Spine Fusion Following Total Hip Arthroplasty: Breaking Up a Happy Home

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.08.029 ◽

2018 ◽

Vol 33 (12) ◽

pp. 3768-3772 ◽

Cited By ~ 9

Author(s):

Connor A. King ◽

David C. Landy ◽

John M. Martell ◽

Hue H. Luu ◽

Lewis L. Shi ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Total Hip ◽

Lumbar Spine Fusion

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

European Spine Journal ◽

10.1007/s00586-019-06201-z ◽

2019 ◽

Vol 29 (2) ◽

pp. 282-294 ◽

Cited By ~ 3

Author(s):

James Randolph Onggo ◽

Mithun Nambiar ◽

Jason Derry Onggo ◽

Kevin Phan ◽

Anuruban Ambikaipalan ◽

...

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Spine Fusion ◽

Total Hip ◽

Lumbar Spine Fusion

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Does Timing of Primary Total Hip Arthroplasty Prior to or After Lumbar Spine Fusion Have an Effect on Dislocation and Revision Rates?

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.01.009 ◽

2019 ◽

Vol 34 (5) ◽

pp. 907-911 ◽

Cited By ~ 16

Author(s):

Arthur L. Malkani ◽

Kevin J. Himschoot ◽

Kevin L. Ong ◽

Edmund C. Lau ◽

Doruk Baykal ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Total Hip ◽

Lumbar Spine Fusion ◽

Primary Total Hip Arthroplasty

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Lumbar Spine Fusion Before Revision Total Hip Arthroplasty Is Associated With Increased Dislocation Rates

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-20-00824 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Christian Klemt ◽

Anand Padmanabha ◽

Venkatsaiakhil Tirumala ◽

Paul Walker ◽

Evan J. Smith ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Lumbar Spine Fusion

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Use of dual mobility cups in patients undergoing primary total hip arthroplasty with prior lumbar spine fusion

International Orthopaedics ◽

10.1007/s00264-020-04507-y ◽

2020 ◽

Vol 44 (5) ◽

pp. 857-862 ◽

Cited By ~ 6

Author(s):

Joseph M. Nessler ◽

Arthur L. Malkani ◽

Shikha Sachdeva ◽

Joseph P. Nessler ◽

Geoff Westrich ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Dual Mobility ◽

Total Hip ◽

Lumbar Spine Fusion ◽

Dual Mobility Cups ◽

Primary Total Hip Arthroplasty

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Preoperative opioid use is a risk factor for complication following revision total hip arthroplasty

Hip International ◽

10.1177/1120700020947400 ◽

2020 ◽

pp. 112070002094740

Author(s):

Jacob M Wilson ◽

Kevin X Farley ◽

Greg A Erens ◽

Thomas L Bradbury ◽

George N Guild

Keyword(s):

Risk Factor ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Healthcare Utilisation ◽

Revision Total Hip Arthroplasty ◽

Opioid Use ◽

Opioid Prescription ◽

Total Hip ◽

Increased Risk ◽

Revision Tha

Background: The demand for revision total hip arthroplasty (THA) procedures continues to increase. A growing body of evidence in primary THA suggests that preoperative opioid use confers increased risk for complication. However, it is unknown whether the same is true for patients undergoing revision procedures. The purpose of this study was to investigate whether or not there was a relationship between preoperative opioid use and surgical complications, medical complications, and healthcare utilisation following revision THA. Methods: This is a retrospective cohort study using the Truven Marketscan database. Patients undergoing revision THA were identified. Preoperative opioid prescriptions were queried for 1 year preoperatively and were used to divide patients into cohorts based on temporality and quantity of opioid use. This included an opioid naïve group as well as an “opioid holiday” group (6 months opioid naïve period after chronic use). Demographic and complication data were collected and both univariate and multivariate analysis was then performed. Results: 62.5% of patients had received an opioid prescription in the year preceding surgery. Patients with continuous preoperative opioid use had higher odds of the following: infection (superficial or deep surgical site infection; OR 1.29; 95% CI, 1.03–1.62, p = 0.029), wound complication (OR 1.36; 95% CI, 1.02–1.82, p = 0.037), sepsis (OR 1.90; 95% CI 1.08–3.34, p = 0.026), and revision surgery (OR 1.54, 95% CI, 1.28–1.85, p < 0.001). This group also had higher care utilisation including extended length of stay, non-home discharge, 90-day readmission, and emergency room visits ( p < 0.001). An opioid holiday mitigated some of this increased risk as this cohort has baseline (i.e. same as opioid naïve) risk ( p > 0.05 for all comparison). Conclusions: Opioid use prior to revision THA is common and is associated with increased risk of postoperative complication. Given that risk was reduced by a preoperative opioid holiday, this represents a modifiable risk factor which should be discussed and addressed preoperatively to optimise outcomes.

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