Does lumbar spine fusion predispose patients to future total hip replacement?

OBJECTIVE Hip-spine syndrome has been well studied since it was first described by Offierski and MacNab in 1983. Today, strong evidence links symptoms of hip and spine pathology to postsurgical outcomes. Recent studies have reported increased rates of hip dislocation in patients previously treated with total hip arthroplasty (THA) who had undergone lumbar fusion procedures. However, the effect of this link on native hip-joint degeneration remains an area of ongoing research. The purpose of this study was to characterize the relationship between use of lumbar fusion procedures and acceleration of hip pathology by analyzing the rate of future THA in patients with preexisting hip osteoarthritis. METHODS This population-level, retrospective cohort study was conducted by using the PearlDiver research program. The initial patient cohort was defined by the presence of diagnosis codes for hip osteoarthritis. Patients were categorized according to use of lumbar fusion after diagnosis of hip pathology. Survival curves with respect to THA were generated by comparison of the no lumbar fusion cohort with the lumbar fusion cohort. To assess the impact of fusion construct length, the lumbar fusion cohort was then stratified according to the number of levels treated (1–2, 3–7, or ≥ 8 levels). Hazard ratios (HRs) were then calculated for the risk factors of number of levels treated, patient age, and sex. RESULTS A total of 2,275,683 patients matched the authors’ inclusion criteria. Log-rank analysis showed no significant difference in the rates of THA over time between the no lumbar fusion cohort (2,239,946 patients) and lumbar fusion cohort (35,737 patients; p = 0.40). When patients were stratified according to number of levels treated, again no differences in the incidence rates of THA over the study period were determined (p = 0.30). Patients aged 70–74 years (HR 0.871, p < 0.001), 75–79 years (HR 0.733, p < 0.001), 80–84 years (HR 0.557, p < 0.001), and ≥ 85 years (HR = 0.275, p < 0.001) were less likely to undergo THA relative to the reference group (patients aged 65–69 years). CONCLUSIONS Although lumbar fusion was initially hypothesized to have a significant effect on rate of THA, lumbar fusion was not associated with increased need for future THA in patients with preexisting hip osteoarthritis. Additionally, there was no relationship between fusion construct length and rate of THA. Although lumbar fusion reportedly increases the risk of hip dislocation in patients with prior THA, these data suggest that lumbar fusion may not clinically accelerate native hip degeneration.

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Comparison of Venous Thromboembolism after Total Hip Arthroplasty between Ankylosing Spondylitis and Osteoarthritis

BioMed Research International ◽

10.1155/2014/712895 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Dongquan Shi ◽

Xingquan Xu ◽

Kai Song ◽

Zhihong Xu ◽

Jin Dai ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Osteoarthritis ◽

Total Hip ◽

Related Data ◽

Vein Thrombosis ◽

Significant Difference ◽

Deep Vein

Objective.Ankylosing spondylitis (AS), an inflammatory rheumatic disease, will gradually lead to severe hip joint dysfunction. Total hip arthroplasty is a useful method to improve patients’ quality of life. The aim of this study was to compare the incidence and risk factors of deep vein thrombosis (DVT) between AS and hip osteoarthritis.Methods.In a retrospective study, a total of 149 subjects who underwent cementless THA were studied. Clinical data, biochemical data, and surgery-related data were measured between AS and OA groups.Results.The incidence of DVT in AS group was lower than that of OA group, although no significant difference was detected (P=0.89). The patients of AS group were much younger (P<0.0001) and thinner (P=0.018) compared with those of OA group. AS patients had higher ejection fraction (EF) (P=0.016), higher platelet counts (P<0.0001), and lower hypertension rate (P=0.0004). The values of APTT, PT, and INR in AS patients were higher than those in OA patients (allP<0.0001). The values of D-dimer and APTT were both significantly higher in DVT subjects than those in non-DVT subjects.Conclusion.AS patients potentially had a lower incidence of DVT compared with OA patients.

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The Local Concentration of Ca2+ Correlates with BMP7 Expression and Osseointegration in Patients with Total Hip Arthroplasty

10.21203/rs.3.rs-33344/v1 ◽

2020 ◽

Author(s):

Xiaodong Fu ◽

Weili Wang ◽

Xiaomiao Li ◽

Yingjian Gao ◽

Hao Li ◽

...

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Local Concentration ◽

Mineral Density ◽

Gruen Zone ◽

Total Hip ◽

Significant Difference ◽

The Impact

Abstract Background A successful osseointegration of total hip arthroplasty (THA) relies on the interplay of implant surface and bone marrow microenvironment. This study was undertaken to investigate the impact of perioperative biochemical molecules (Ca 2+ , Mg 2+ , Zn 2+ , VD, PTH) on the bone marrow osteogenetic factors (BMP2, BMP7, Stro-1 + cells) in the metaphyseal region of the femoral head, and further on the bone mineral density (BMD) of Gruen R3. Methods Bone marrow aspirates were obtained from the discarded metaphysis region of the femoral head in 51 patients with THA. Flow cytometry was used to measure the Stro-1 + expressing cells. ELISA was used to measure the concentrations of bone morphologic proteins (BMP2 and BMP7). The perioperative concentrations of the biochemical molecules above were measured by radioimmunoassay. The BMD of Gruen zone R3 was examined at 6 months after THA, using dual-energy X-ray absorptiometry (DEXA). Results Our data demonstrated that the concentration of Ca 2+ was positively correlated with BMP7 expression, and with the postoperative BMD of Gruen zone R3. However, the concentration of Mg 2+ had little impact on the R3 BMD, although it was negatively correlated with the expression of BMP7. The data also suggested that the other biochemical molecules, such as Zn 2+ , VD, and PTH, were not significantly correlated with any bone marrow osteogenetic factors (BMP2, BMP7, Stro-1 + cells). The postoperative R3 BMD of patients of different gender and age had no significant difference. Conclusions These results indicate the local concentration of Ca 2+ may be an indicator for the prognosis of THA patients.

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Evaluation of the impact of preoperative assessment on length of stay after a total hip arthroplasty

British Journal of Occupational Therapy ◽

10.1177/0308022616685583 ◽

2017 ◽

Vol 80 (6) ◽

pp. 361-367

Author(s):

Daniel Harte ◽

Philip Hamill ◽

Caroline Williams-Condell ◽

Stephanie Lewis

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Preoperative Assessment ◽

Allied Health Professionals ◽

Clinical Notes ◽

Total Hip ◽

Significant Difference ◽

Care Package ◽

The Impact

Introduction To investigate if preoperative assessment delivered by occupational therapists, physiotherapists and social workers for people awaiting a total hip arthroplasty decreased the length of stay in hospital postoperatively. Method A retrospective data review was conducted on all patients who had a primary total hip arthroplasty across a 6-month period. A total of 101 patients (mean age 67.16 years) was included in this evaluation. Clinical notes were used to determine which patients attended or did not attend preoperative assessment. Statistical modeling was used to analyse the association of a series of variables and time spent in hospital after a total hip arthroplasty. Results There was no significant difference in the length of stay for patients who attended preoperative assessment ( P < 0.05) while patients who were medically unfit, lived alone and/or required a care package experienced a significantly higher length of stay ( P < 0.05). Conclusion These results do not support the British Orthopaedic Association’s recommendation that preoperative assessment delivered by allied health professionals helps reduce length of stay. However, it identifies variables which could be managed potentially to reduce length of stay. A large multisite clinical trial is required to determine if preoperative assessment reduces length of stay for people undergoing this surgical procedure.

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Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

Journal of Clinical Medicine ◽

10.3390/jcm9103203 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3203

Author(s):

Takahisa Ogawa ◽

Toshitaka Yoshii ◽

Mutsuko Moriwaki ◽

Shingo Morishita ◽

Yoto Oh ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Propensity Score ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Arthroplasty ◽

Perioperative Complications ◽

Hip Dislocation ◽

Total Hip ◽

Significant Difference ◽

Neck Fracture

Previous studies have shown better clinical outcomes after total hip arthroplasty (THA) compared to hemiarthroplasty (HA) for displaced femoral neck fracture. However, few studies have focused on the surgical risks of the two procedures. Therefore, we investigated the perioperative complications of HA and THA in femoral neck fracture, using a large nationwide inpatient database. A total of 286,269 patients (281,140 patients with HA and 5129 with THA) with a mean age of 81.7 were enrolled and HA and THA patients were matched by a propensity score to adjust for patient and hospital characteristics. Patients in a matched cohort were analyzed to compare complications and mortality. The systemic complication rate was not significantly different after a propensity score matching of 4967 pairs of patients. However, the incidence of both hip dislocation and revision surgery was more frequent in the THA group (Risk difference (RD), 2.74; 95% Confidence interval (CI), 2.21–3.27; p < 0.001; RD, 2.82; 95% CI, 2.27–3.37; p < 0.001, respectively). There was no significant difference in 30 day in-hospital mortality among the two groups. The risk of dislocation and reoperation was higher for THA than for HA in elderly patients with a femoral neck fracture in this retrospective study using a nationwide database.

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Chronological Changes in Functional Cup Position at 10 Years after Total Hip Arthroplasty

Hip International ◽

10.5301/hipint.5000487 ◽

2017 ◽

Vol 27 (5) ◽

pp. 477-482 ◽

Cited By ~ 10

Author(s):

Yusuke Okanoue ◽

Masahiko Ikeuchi ◽

Shogo Takaya ◽

Masashi Izumi ◽

Koji Aso ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Osteoarthritis ◽

Standing Position ◽

Anterior Dislocation ◽

Total Hip ◽

Postoperative Change ◽

Significant Difference ◽

Cup Position

Purpose This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period. Methods We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery. Results Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion. Conclusions Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.

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Impact of Surgeon Handedness in Manual and Robot-assisted Total Hip Arthroplasty

10.21203/rs.2.19557/v1 ◽

2019 ◽

Author(s):

Xiangpeng Kong ◽

Minzhi Yang ◽

Xiang Li ◽

Ming Ni ◽

Guoqiang Zhang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Adverse Impact ◽

Harris Hip Score ◽

Robot Assisted ◽

Total Hip ◽

Significant Difference ◽

Manual Group ◽

The Impact ◽

Cup Positioning

Abstract Background The purpose of this study was to examine whether surgeon handedness could affect cup positioning in manual total hip arthroplasty (THA), and whether robot could diminish or eliminate the impact of surgeon handedness on cup positioning in robot-assisted THA.Methods Fifty-three patients who underwent bilateral robot-assisted THA and sixty-two patients who underwent bilateral manual THA between August 2018 and July 2019 in our institute were respectively analyzed in this study. When the difference between the bilateral anteversion or inclination was greater than 5°, the patient was regarded as having different cup positioning between bilateral THA. Their demographics, orientation of acetabular cup and postoperative 3 month Harris hip score (HHS) were recorded for analysis.Results There were no significant difference in the gender, age, BMI, diagnosis's composition, preoperative and postoperative HHS between the robotic and manual group. Two left hips dislocated in the manual group. The anteversion of left hip was significantly larger than that of right hip (24.77±10.44 vs 22.44±8.67, p=0.043) in the manual group. There were no significant difference of cup positioning between bilateral robot-assisted THA. The patients in manual group were significantly more likely to have different cup positioning between bilateral hips than those in robotic group (77% vs 45%, p=0.000).Conclusions Surgeon's handedness had adverse impact on anteversion of the non-dominant side in manual THA and right-handed surgeons were more likely to place the left cup in larger anteversion. Robot could help surgeon eliminate the adverse impact caused by personal innate handedness.

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How much does lumbar fusion change sagittal pelvic tilt in individuals receiving total hip arthroplasty?

Arthroplasty ◽

10.1186/s42836-019-0014-4 ◽

2019 ◽

Vol 1 (1) ◽

Author(s):

Gangyong Huang ◽

Guanglei Zhao ◽

Kangming Chen ◽

Yibing Wei ◽

Siqun Wang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Pelvic Tilt ◽

Lumbar Fusion ◽

Harris Hip Score ◽

Control Groups ◽

Total Hip ◽

Significant Difference ◽

The Mean ◽

And Control

Abstract Background This study primarily aims to examine the effect of lumbar fusion on changes in sagittal pelvic tilt (SPT) in total hip arthroplasty (THA) patients. Methods We reviewed 19 hip osteoarthritic patients undergoing THA with or without lumbar fusion. The gender, age, primary disease, Deyo comorbidity score, and year of surgery were sorted and matched. All patients were followed up for at least 12 months. They were compared in terms of the SPT angle, Harris hip score (HHS) and complications. Results On average, the patients receiving lumbar fusion had a − 3.9 (95% CI − 7.7 to − 1.5) degrees of SPT before THA and − 2.7 (95% CI − 6.5 to 1.1) degrees postoperatively, and the THA patients without lumbar fusion averaged 2.5 (95% CI − 0.1 to 5.0) degrees and 4.2 (95% CI 2.0 to 6.4) degrees, respectively. In the lumbar fusion patients, the mean SPT was − 3.9 (95% CI − 9.9 to 2.0) degrees with L5S1 fusion and − 4.0(95% CI − 10.0 to 2.1) degrees without L5S1 fusion on the standing radiograph before THA (t = 0.01, P = 0.99). The mean SPT was − 1.2 (95% CI − 4.9 to 2.6) degrees with one- and two-segment fusion and − 10.0 (95% CI − 18.5 to 1.5) degrees with three- and four-segment fusion before THA (t = 2.60, P = 0.02). There was no statistically significant difference in cup inclination and cup anteversion after THA between the lumbar fusion and control groups. These patients in the two groups achieved a similar HHS 12 months after THA despite the fact that they had different SPT and HHS before THA. Conclusion Lumbar fusion appears to increase the posterior SPT by approximately 6 degrees in the patients undergoing THA. Lumbar fusion of more than two segments is a predictor of more posterior SPT changes, but fusion of L5S1 is not.

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Lumbar fusion involving the sacrum increases dislocation risk in primary total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b2.bjj-2018-0754.r1 ◽

2019 ◽

Vol 101-B (2) ◽

pp. 198-206 ◽

Cited By ~ 30

Author(s):

C. G. Salib ◽

N. Reina ◽

K. I. Perry ◽

M. J. Taunton ◽

D. J. Berry ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lumbar Fusion ◽

Statistical Significance ◽

Control Group ◽

Total Hip ◽

Significant Difference ◽

Anterior Pelvic Tilt ◽

Postoperative Dislocation ◽

Primary Total Hip Arthroplasty

AimsConcurrent hip and spine pathologies can alter the biomechanics of spinopelvic mobility in primary total hip arthroplasty (THA). This study examines how differences in pelvic orientation of patients with spine fusions can increase the risk of dislocation risk after THA.Patients and MethodsWe identified 84 patients (97 THAs) between 1998 and 2015 who had undergone spinal fusion prior to primary THA. Patients were stratified into three groups depending on the length of lumbar fusion and whether or not the sacrum was involved. Mean age was 71 years (40 to 87) and 54 patients (56%) were female. The mean body mass index (BMI) was 30 kg/m2(19 to 45). Mean follow-up was six years (2 to 17). Patients were 1:2 matched to patients with primary THAs without spine fusion. Hazard ratios (HR) were calculated.ResultsDislocation in the fusion group was 5.2% at one year versus 1.7% in controls but this did not reach statistical significance (HR 1.9; p = 0.33). Compared with controls, there was no significant difference in rate of dislocation in patients without a sacral fusion. When the sacrum was involved, the rate of dislocation was significantly higher than in controls (HR 4.5; p = 0.03), with a trend to more dislocations in longer lumbosacral fusions. Patient demographics and surgical characteristics of THA (i.e. surgical approach and femoral head diameter) did not significantly impact risk of dislocation (p > 0.05). Significant radiological differences were measured in mean anterior pelvic tilt between the one-level lumbar fusion group (22°), the multiple-level fusion group (27°), and the sacral fusion group (32°; p < 0.01). Ten-year survival was 93% in the fusion group and 95% in controls (HR 1.2; p = 0.8).ConclusionLumbosacral spinal fusions prior to THA increase the risk of dislocation within the first six months. Fusions involving the sacrum with multiple levels of lumbar involvement notably increased the risk of postoperative dislocation compared with a control group and other lumbar fusions. Surgeons should take care with component positioning and may consider higher stability implants in this high-risk cohort.

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Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade I degenerative lumbar spondylolisthesis?

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine202059 ◽

2021 ◽

pp. 1-8

Author(s):

Andrew K. Chan ◽

Praveen V. Mummaneni ◽

John F. Burke ◽

Rory R. Mayer ◽

Erica F. Bisson ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Rating Scale ◽

Lumbar Fusion ◽

Radiographic Appearance ◽

Lumbar Decompression ◽

Significant Difference ◽

Degenerative Lumbar Spondylolisthesis ◽

Patient Reported ◽

Lumbar Spondylolisthesis ◽

The Impact

OBJECTIVE Reduction of Meyerding grade is often performed during fusion for spondylolisthesis. Although radiographic appearance may improve, correlation with patient-reported outcomes (PROs) is rarely reported. In this study, the authors’ aim was to assess the impact of spondylolisthesis reduction on 24-month PRO measures after decompression and fusion surgery for Meyerding grade I degenerative lumbar spondylolisthesis. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing posterior lumbar fusion for spondylolisthesis with a minimum 24-month follow-up, and quantitative correlation between Meyerding slippage reduction and PROs was performed. Baseline and 24-month PROs, including the Oswestry Disability Index (ODI), EQ-5D, Numeric Rating Scale (NRS)–back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society patient satisfaction questionnaire) scores were noted. Multivariable regression models were fitted for 24-month PROs and complications after adjusting for an array of preoperative and surgical variables. Data were analyzed for magnitude of slippage reduction and correlated with PROs. Patients were divided into two groups: < 3 mm reduction and ≥ 3 mm reduction. RESULTS Of 608 patients from 12 participating sites, 206 patients with complete data were identified in the QOD and included in this study. Baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts except for depression, listhesis magnitude, and the proportion with dynamic listhesis (which were accounted for in the multivariable analysis). One hundred four (50.5%) patients underwent lumbar decompression and fusion with slippage reduction ≥ 3 mm (mean 5.19, range 3 to 11), and 102 (49.5%) patients underwent lumbar decompression and fusion with slippage reduction < 3 mm (mean 0.41, range 2 to −2). Patients in both groups (slippage reduction ≥ 3 mm, and slippage reduction < 3 mm) reported significant improvement in all primary patient reported outcomes (all p < 0.001). There was no significant difference with regard to the PROs between patients with or without intraoperative reduction of listhesis on univariate and multivariable analyses (ODI, EQ-5D, NRS-BP, NRS-LP, or satisfaction). There was no significant difference in complications between cohorts. CONCLUSIONS Significant improvement was found in terms of all PROs in patients undergoing decompression and fusion for lumbar spondylolisthesis. There was no correlation with clinical outcomes and magnitude of Meyerding slippage reduction.

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Overlapping single-level lumbar fusion and adverse short-term outcomes

Journal of Neurosurgery Spine ◽

10.3171/2020.12.spine201861 ◽

2021 ◽

pp. 1-12

Author(s):

Ali S. Farooqi ◽

Donald K. E. Detchou ◽

Gregory Glauser ◽

Krista Strouz ◽

Scott D. McClintock ◽

...

Keyword(s):

Lumbar Fusion ◽

Demographic Data ◽

Univariate Analysis ◽

P Value ◽

Matched Cohort ◽

Short Term ◽

Single Level ◽

Significant Difference ◽

Duration Of Surgery ◽

The Impact

OBJECTIVE There is a paucity of research on the safety of overlapping surgery. The purpose of this study was to evaluate the impact of overlapping surgery on a homogenous population of exactly matched patients undergoing single-level, posterior-only lumbar fusion. METHODS The authors retrospectively analyzed case data of 3799 consecutive adult patients who underwent single-level, posterior-only lumbar fusion during a 6-year period (June 7, 2013, to April 29, 2019) at a multihospital university health system. Outcomes included 30-day emergency department (ED) visit, readmission, reoperation, and morbidity and mortality following surgery. Thereafter, coarsened exact matching was used to match patients with and without overlap on key demographic factors, including American Society of Anesthesiologists (ASA) class, Charlson Comorbidity Index (CCI) score, sex, and body mass index (BMI), among others. Patients were subsequently matched by both demographic data and by the specific surgeon performing the operation. Univariate analysis was carried out on the whole population, the demographically matched cohort, and the surgeon-matched cohort, with significance set at a p value < 0.05. RESULTS There was no significant difference in morbidity or any short-term outcome, including readmission, reoperation, ED evaluation, and mortality. Among the demographically matched cohort and surgeon-matched cohort, there was no significant difference in age, sex, history of prior surgery, ASA class, or CCI score. Overlapping surgery patients in both the demographically matched cohort and the matched cohort limited by surgeon had longer durations of surgery (p < 0.01), but no increased morbidity or mortality was noted. Patients selected for overlap had fewer prior surgeries and lower ASA class and CCI score (p < 0.01). Patients with overlap also had a longer duration of surgery (p < 0.01) but not duration of closure. CONCLUSIONS Exactly matched patients undergoing overlapping single-level lumbar fusion procedures had no increased short-term morbidity or mortality; however, duration of surgery was 20 minutes longer on average for overlapping operations. Further studies should assess long-term patient outcomes and the impact of overlap in this and other surgical procedures.

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