Early Outcomes of Primary Total Hip Arthroplasty After Prior Lumbar Spinal Fusion

Barry, Jeffrey J.; Sing, David C.; Vail, Thomas P.; Hansen, Erik N.

doi:10.1016/j.arth.2016.07.019

Cited by 70 publications

(73 citation statements)

References 27 publications

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“…A body of evidence has demonstrated the increased risk of dislocation and revision in patients undergoing THA with adult spinal deformity [6,26], fixed spinopelvic alignment, [10] history of lumbar fusion [27][28][29], and noninstrumented spinal disease [6]. Several studies have also demonstrated an increased risk of dislocation after primary [16,18] and revision THA [17] in obese compared with normal-weight patients.…”

Section: Discussionmentioning

confidence: 99%

Obesity Alters Spinopelvic Alignment Changes From Standing to Relaxed Sitting: the Influence of the Soft-tissue Envelope

et al. 2020

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Background: Changes in spinopelvic and lower extremity alignment between standing and relaxed sitting have important clinical implications with regard to stability of total hip arthroplasty. This study aimed to analyze the effect of body mass index (BMI) on lumbopelvic alignment and motion at the hip joint. Methods: A retrospective review of patients who underwent full-body stereoradiographs in standing and relaxed sitting for total hip arthroplasty planning was conducted. Spinopelvic parameters measured included spinopelvic tilt (SPT), pelvic incidence (PI), lumbar lordosis (LL), PI minus LL (PI-LL), proximal femoral shaft angle (PFSA), and standing-to-sitting hip range of motion. Propensity score matching controlled for age, gender, PI, and hip ostoarthritis grade. Patients were stratified into normal (NORMAL; BMI, 18.5-24.9), overweight (OW; 25.0-29.9), and obese (OB; 30.0-34.9) groups. Alignment parameters were compared using one-way analysis of variance. Results: There were 84 patients in each group after propensity score matching. Standing alignment between BMI groups was similar for all parameters (P > .05) except for PFSA (P < .001). Significant differences were noted for sitting alignment between patients who are NORMAL, OW, and OB in: SPT (P ¼ .007), PILL (P ¼ .018), and LL (P ¼ .029). PFSA between groups was not significantly different (P > .05). Significant differences were found for sitting-to-standing alignment across groups in PFSA change (P < .001), SPT change (P ¼ .006), PILL change (P ¼ .005), LL change (P ¼ .037), and hip flexion (P < .001). Conclusions: Significant differences in sitting and standing-to-sitting change in lumbopelvic alignment based on BMI suggest obese patients recruit more posterior spinopelvic tilt when sitting to compensate for soft-tissue impingement that occurs anterior to the hip joint and limiting hip flexion.

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Section: Discussionmentioning

confidence: 99%

Obesity Alters Spinopelvic Alignment Changes From Standing to Relaxed Sitting: the Influence of the Soft-tissue Envelope

et al. 2020

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“…Certain studies investigated the influence of adult spine deformity on THA and found an increased risk of THA dislocation and revision surgery when compared to patients without severe spinal pathologies [ 32 , 41 , 63 , 64 ]. Several studies examined the outcome of THA on previous lumbosacral fusion and noted an increased incidence of THA dislocations and revision surgery, with a positive correlation to the number of segments fused (3–7 segments versus one or two segments) [ 43 , 45 , 46 , 65 , 66 ].…”

Section: Implications For Spine Surgeonsmentioning

confidence: 99%

The Impact of Spinopelvic Mobility on Arthroplasty: Implications for Hip and Spine Surgeons

Haffer

Amini

Perka

et al. 2020

JCM

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Spinopelvic mobility represents the complex interaction of hip, pelvis, and spine. Understanding this interaction is relevant for both arthroplasty and spine surgeons, as a predicted increasing number of patients will suffer from hip and spinal pathologies simultaneously. We conducted a comprehensive literature review, defined the nomenclature, summarized the various classifications of spinopelvic mobility, and outlined the corresponding treatment algorithms. In addition, we developed a step-by-step workup for spinopelvic mobility and total hip arthroplasty (THA). Normal spinopelvic mobility changes from standing to sitting; the hip flexes, and the posterior pelvic tilt increases with a concomitant increase in acetabular anteversion and decreasing lumbar lordosis. Most classifications are based on a division of spinopelvic mobility based on ΔSS (sacral slope) into stiff, normal, and hypermobile, and a categorization of the sagittal spinal balance regarding pelvic incidence (PI) and lumbar lordosis (LL) mismatch (PI–LL = ± 10° balanced versus PI–LL > 10° unbalanced) and corresponding adjustment of the acetabular component implantation. When performing THA, patients with suspected pathologic spinopelvic mobility should be identified by medical history and examination, and a radiological evaluation (a.p. pelvis standing and lateral femur to L1 or C7 (if EOS (EOS imaging, Paris, France) is available), respectively, for standing and sitting radiographs) of spinopelvic parameters should be conducted in order to classify the patient and determine the appropriate treatment strategy. Spine surgeons, before planned spinal fusion in the presence of osteoarthritis of the hip, should consider a hip flexion contracture and inform the patient of an increased risk of complications with existing or planned THA.

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“…Additionally, these patients have worse outcomes following total hip arthroplasty. [2][3][4][5] However, there has been a paucity of research on patient-reported outcomes (PROs) and complications in patients with a history of lumbar spine surgery undergoing hip arthroscopy for the treatment of FAI.…”

Section: See Related Article On Page 443mentioning

confidence: 99%

Editorial Commentary: The Hip-Spine Connection in Patients Undergoing Hip Arthroscopy: Should We Learn From Total Hip Replacement and Counsel Patients Differently If They Have Had Previous Back Surgery?

Pascual‐Garrido¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Disorders of the adult hip and spine are common, and there is evidence that there is a hip-spine connection in patients with hip femoroacetabular impingement (FAI). Many reports have shown that patients undergoing lumbar fusion and subsequent total hip arthroplasty have a higher risk of complications and worse outcomes following total hip arthroplasty. However, there has been a paucity of research on the effect of a history of lumbar spine surgery in patients undergoing hip arthroscopy for the treatment of FAI. Variations in lumbar lordosis, pelvic incidence, tilt, and sacral slope may modify the degree of FAI, symptoms, and patient-reported outcomes following hip arthroscopy. In the future, we should continue our efforts to better understand the impact that limited range of motion in the spine has in joint mechanics of the hip and the possibility of affecting patient-reported outcomes after hip arthroscopy. Future studies incorporating novel imaging technology, such as EOS, may be an objective way of assessing the effect of abnormal spine-pelvic function in patients with hip FAI.

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Early Outcomes of Primary Total Hip Arthroplasty After Prior Lumbar Spinal Fusion

Cited by 70 publications

References 27 publications

Obesity Alters Spinopelvic Alignment Changes From Standing to Relaxed Sitting: the Influence of the Soft-tissue Envelope

Obesity Alters Spinopelvic Alignment Changes From Standing to Relaxed Sitting: the Influence of the Soft-tissue Envelope

The Impact of Spinopelvic Mobility on Arthroplasty: Implications for Hip and Spine Surgeons

Editorial Commentary: The Hip-Spine Connection in Patients Undergoing Hip Arthroscopy: Should We Learn From Total Hip Replacement and Counsel Patients Differently If They Have Had Previous Back Surgery?

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