Prior Lumbar Spinal Arthrodesis Increases Risk of Prosthetic-Related Complication in Total Hip Arthroplasty

Sing, David C.; Barry, Jeffrey J.; Aguilar, Thomas U.; Theologis, Alexander A.; Patterson, Joseph T.; Tay, Bobby; Vail, Thomas P.; Hansen, Erik N.

doi:10.1016/j.arth.2016.02.069

Cited by 95 publications

(94 citation statements)

References 24 publications

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“…When patients have a limited ROM in the lumbar spine, the risk of dislocation and need for revision after THA increases markedly./ Based on a 12-month follow-up, Perfetti et al reported that, compared to the controls, the THA patients with prior spinal fusion were 7 times more likely to dislocate their prostheses (p < 0.01) and 4 times more likely to need revisions (p < 0.01), [10]. Sing et al reported that the dislocation rate was 2.4% for THA patients without prior spinal fusion, 4.3% for patients with 1 to 2 levels fused, and 7.5% for patients with 3 to 5 levels fused [11]. In this study, patients with previous spine surgery were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…McGregor et al (1997) reported that patients with a degenerative lumbar spine or disc prolapse have an approximately 10°decrease in flexion and extension compared to the age-matched controls [9]. Lumbar spine movement reduction results in greater risk of dislocation and revision after THA [10,11]. Elucidation and measurement of the effects of lumbar disc degeneration on spinopelvic movement are, thus, essential when preparing patients for THA.…”

Section: Introductionmentioning

confidence: 99%

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Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

Feng

et al. 2020

BMC Musculoskelet Disord

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Background: Limitations in the lumbar spine movement reduce lumbar vertebral motion and affect spinopelvic kinematics. We studied the influence of lumbar intervertebral disc degeneration on spinofemoral movement, from standing to sitting, in patients undergoing total hip arthroplasty (THA). Methods: Of 138 consecutive patients scheduled for THA due to unilateral avascular necrosis (AVN) of the femoral head, those with ≥3 discs with University of California at Los Angeles (UCLA) disc degeneration score > 1 were defined as the lumbar degenerative disc disease (LDD) group, and the remaining patients constituted d the control group. Full body anteroposterior and lateral EOS images in the standing and sitting positions were obtained. Pelvic incidence (PI), L1 slope (L1 s), lumbar lordosis angle (LL), pelvic tilt (PT), sacral slope (SS), femoral slope (Fs), sagittal vertical axis (SVA), hip flexion, lumbar spine flexion, and total spinofemoral flexion were measured on the images and compared between groups. Results: No significant between-group differences were observed in the height, weight, body mass index, AVN staging, or PI, SS, and Fs on standing. The LDD group included more females and older patients, had 5°lesser LL, 5°g reater PT, and larger SVA. From standing to sitting, the PI remained constant in both groups. Total spinofemoral flexion was 7°less, lumbar spine flexion 16°less, L1 slope change 6°less, and SS change 8°less, and hip flexion was 7°more in the LDD than in the control group. The spine/hip flexion ratio was significantly lower in the LDD group (0.3 versus 0.7; p < 0.001). On regression analysis, the LDD group (p < 0.001) and older age (p = 0.048) but not sex, weight, or height were significant univariate predictors of decreased spine/hip ratio. Conclusions: Patients with LDD leant more forward and had a larger pelvis posterior tilt angle on standing and a decreased lumbar spine/hip flexion ratio, with more hip joint flexion, on sitting, to compensate for reduced lumbar spine flexion. Surgeons should be aware that elderly patients with multiple LDD have significantly different spinofemoral movements and increased risk of posterior dislocation post-THA. Preoperative patient identification, intraoperative surgical technique modification, and individualized rehabilitation protocols are necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

Feng

et al. 2020

BMC Musculoskelet Disord

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“…The comparison showed a statistically significant difference P < 0.01 in the rate of dislocation at 12 months after THA, which is 3% for patients with a history of lumbar fusion and 0.4% for patients without the history of lumbar fusion. The study by Sing et al . demonstrated that, as compared to simple THA for the first time, postoperative dislocation, revision, prosthesis loosening, and other complications increase significantly in patients with a history of lumbar fusion to undergo THA.…”

Section: Effects Of Spinal Diseases On Thamentioning

confidence: 99%

The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis

Yang

Zhang

2019

Orthopaedic Surgery

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The concept of the “safe area” of the acetabular prosthesis has a long history and has been recognized by many scholars. It is generally believed that postoperative hip dislocation rate is low, when the acetabular anteversion angle is placed in the range of 15° ± 10°. Despite this, hip dislocation is a common complication after total hip arthroplasty. In recent years, more and more scholars have paid attention to the influence of pelvic tilt on the acetabular anteversion angle. The concept of acetabular anteversion changes as the pelvic tilt changes, and is challenging the traditional acetabular prosthesis “safe area.” This study summarized the potential influencing factors of pelvic tilt and discussed the influence of the phenomenon on the anteversion angle of total hip arthroplasty (THA) acetabular prosthesis based on the literature review. We conclude that from the supine position to standing, followed by sitting, the pelvis tends to move backward. Pelvic sagittal activity, lumbar disease (ankylosing spondylitis), lumbar fusion (lumbar fusion, spine‐pelvic fusion), and other factors related to the tilt are THA risk factors for postoperative dislocation and revision. With the change of body position, the degree of acetabular anteversion is directly related to the degree of pelvic tilt. The acetabular anteversion varies greatly, which leads to increased hip prosthesis wear and even hip dislocation. The lateral X‐ray of the spine and pelvis is recommended in supine, standing, and sitting positions before THA. In addition, the pelvic tilt should be regarded as a reference of the acetabular prosthesis in the preoperative planning of 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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Prior Lumbar Spinal Arthrodesis Increases Risk of Prosthetic-Related Complication in Total Hip Arthroplasty

Cited by 95 publications

References 24 publications

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis

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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