Total hip arthroplasty and lumbar spine disorders: Plain co-existence or mutual influence?

Lumbar spine disorders (LSD) might influence the outcome after total hip arthroplasty (THA). Despite a known common prevalence of LSD and degenerative hip disorders, this study investigates their mutual influence in case of co-existence with the purpose to advance surgeons planning and patient’s prognosis. Patients with and without LSD were compared before and at the one-year postoperative examination. For clinical evaluation the WOMAC was assessed. The radiological analysis focused on cup anteversion and inclination. The total group included 203 consecutive patients. The overall incidence of LSD was 51.0%. Patients with LSD were on average 4.3 years older and had a 1.8 higher BMI than non-LSD patients (P<0.05). The cup positioning and the clinical results were comparable between both groups before and at the last time of follow up (P>0.05). No hip dislocations nor clinical signs of impingement were seen.We can conclude that there is a high degree of co-existence of LSD and hip disorders. However, a strong negative impact of LSD to clinical or radiologic results could not be confirmed in our study.

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Clinical Results of Total Hip Arthroplasty in Two Patients with Charcot Hip Joints due to Congenital Insensivity to Pain with Anhydrosis

Case Reports in Orthopedics ◽

10.1155/2018/1743068 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Daisuke Inoue ◽

Tamon Kabata ◽

Yoshitomo Kajino ◽

Tadashi Taga ◽

Takashi Yamamoto ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Clinical Signs ◽

Clinical Results ◽

Long Term Results ◽

X Rays ◽

Hip Joints ◽

Total Hip ◽

Continuous Use

Traditionally, Charcot arthropathy has been considered an absolute contraindication for total hip arthroplasty (THA). However, some recent reports have shown that good short- to mid-term results can be achieved by improving the durability of the implant. This paper reports the mid- to long-term results of THA in two patients with Charcot hip joints caused by congenital insensivity to pain with anhydrosis. Both patients suffered multiple posterior dislocations in the six months immediately following surgery. However, with the continuous use of a hard abduction brace, one patient was eventually able to walk with a lofstrand cane and the other with the use of one crutch. Although one patient experienced a dislocation five years after surgery, X-rays taken after nine years and five years, respectively, revealed no clinical signs of implant loosening. We conclude that, with careful planning and appropriate precautions, THA may be a viable treatment option for Charcot hip joints caused by congenital insensivity to pain with anhydrosis.

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Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty

The Spine Journal ◽

10.1016/j.spinee.2011.11.002 ◽

2012 ◽

Vol 12 (5) ◽

pp. 363-369 ◽

Cited By ~ 30

Author(s):

Heidi Prather ◽

Linda R. Van Dillen ◽

Steven M. Kymes ◽

Melissa A. Armbrecht ◽

Dustin Stwalley ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Total Hip ◽

Spine Disorders

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Clinical, functional and radiographic outcomes after revision total hip arthroplasty with tapered fluted modular or non-modular stems: a systematic review

Hip International ◽

10.1177/11207000211004383 ◽

2021 ◽

pp. 112070002110043

Author(s):

Antonios A Koutalos ◽

Sokratis Varitimidis ◽

Konstantinos N Malizos ◽

Theofilos Karachalios

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Rate ◽

Clinical Results ◽

Fracture Rate ◽

Revision Total Hip Arthroplasty ◽

Term Survival ◽

Total Hip ◽

Radiographic Outcomes

Purpose: The aim of the study was to systematically evaluate clinical outcomes of tapered fluted stems, either monoblock or modular, in revision total hip arthroplasty. Methods: PubMed, EMBASE and Web of Science and Cochrane databases were systematically searched by 2 researchers. Clinical studies reporting primarily on survival and re-revision rates, and secondarily on subsidence, dislocation, intraoperative fractures, periprosthetic fractures and infection were included. 2 investigators assessed the quality of the studies. Results: 46 studies were included in this review, reporting on 4601 stem revisions. The pooled re-revision rate was 5.1% and long-term survival ranged from 75% to 98.5%. No differences were observed between monoblock and modular stems regarding re-revision rate, dislocation rate, periprosthetic fracture rate or infection rates. Monoblock stems exhibited more subsidence and modular stems displayed more intraoperative fractures. Conclusions: Satisfactory results can be obtained with the use of tapered fluted end-bearing stems. Monoblock stems offer the same clinical results as modular stems.

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Degenerative Lumbar Spine Disease, Not Fusion, May Be a Risk Factor for Instability after Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0040-1719114 ◽

2020 ◽

Vol 4 (04) ◽

pp. 193-200

Author(s):

Daniel K. Witmer ◽

Evan R. Deckard ◽

R. Michael Meneghini

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Joint Disease ◽

Total Hip ◽

Female Sex ◽

Lumbar Spine Fusion ◽

Radiographic Measurements ◽

Acetabular Protrusio

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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Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty?

The Bone & Joint Journal ◽

10.1302/0301-620x.101b8.bjj-2019-0106.r1 ◽

2019 ◽

Vol 101-B (8) ◽

pp. 902-909 ◽

Cited By ~ 8

Author(s):

M. M. Innmann ◽

C. Merle ◽

T. Gotterbarm ◽

V. Ewerbeck ◽

P. E. Beaulé ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Reported Outcome Measures ◽

Screening Tools ◽

Sacral Slope ◽

Sitting Position ◽

Total Hip ◽

Patient Reported ◽

Hip Flexion

Aims This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. Patients and Methods A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. Results Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. Conclusion The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902–909.

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