Retrospective Study OBJECTIVE.: To determine how LSF-THA operative sequence would affect THA outcomes.
SUMMARY OF BACKGROUND DATA:
Outcomes following total hip arthroplasty (THA) in patients with a history of lumbar spinal degenerative disease and fusion are incompletely understood.
The PearlDiver Research Program (http://www.pearldiverinc.com) was used to identify patients undergoing primary THA. Patients were divided into four cohorts: 1) Primary THA without spine pathology, 2) remote LSF prior to hip pathology and THA, and patients with concurrent hip and spinal pathology that had 3) THA following LSF, and 4) THA prior to LSF. Postoperative complications and opioid use were assessed with multivariable logistic regression to determine the effect of spinal degenerative disease and operative sequence.
Between 2007 and 2017, 85,595 patients underwent primary THA, of which 93.6% had THA without lumbar spine degenerative disease, 0.7% had a history of remote LSF, and those with concurrent hip and spine pathology, 1.6% had THA prior to LSF, and 2.4% had THA following LSF. Patients with hip and lumbar spine pathology who underwent THA prior to LSF had significantly higher rates of dislocation (aOR = 2.46, p < 0.0001), infection (aOR = 2.65, p < 0.0001), revision surgery (aOR = 1.91, p < 0.0001), and postoperative opioid use at 1 month (aOR: 1.63, p < 0.001), 3 months (aOR = 1.80, p < 0.001), 6 months (aOR: 2.69, p < 0.001), and 12 months (aOR = 3.28, p < 0.001) compared to those treated with THA following LSF.
Patients with degenerative hip and lumbar spine pathology that undergo THA prior to LSF have a significantly increased risk of postoperative dislocation, infection, revision surgery, and prolonged opioid use compared to THA after LSF. Surgeons should consider the surgical sequence of THA and LSF on outcomes for patients with this dual pathology. Shared decision making between patients, spine surgeons, and arthroplasty surgeons is necessary to optimize outcomes in patients with concomitant hip and spine pathology.
LEVEL OF EVIDENCE: