Challenges in Total Hip Arthroplasty with Prior Spinal Arthrodesis: A Comprehensive Review of Biomechanics, Complications, and Surgical Strategies

Abstract

Total hip arthroplasty (THA) has revolutionized patients’ lives with hip osteoarthritis. However, the increasing prevalence of THA in individuals with prior lumbar arthrodesis (LA) poses unique challenges. This review delves into the biomechanical alterations, complications, and surgical strategies specific to this patient subset, highlighting the need for tailored preoperative assessments and planning. Due to altered pelvic and spinal biomechanics, patients with LA undergoing THA face a higher risk of dislocation and revision. The complex interplay between spinal and hip biomechanics underscores the need for meticulous preoperative planning. Comprehensive clinical examination and radiographic evaluation are vital for understanding patient-specific challenges. Various radiographic techniques, including computed tomography (CT)/X-ray matching and standing/seated studies, provide insights into postural changes affecting pelvic and spinal alignment. Complications following THA in patients with LA highlight the necessity for personalized surgical strategies. Careful consideration of implant selection, the surgical approach, and component positioning are essential to prevent complications. In summary, THA in patients with prior LA demands individualized preoperative assessments and planning. This approach is crucial to optimize outcomes and mitigate the heightened risks of complications, underlining the importance of tailored surgical strategies.