Superior outcomes of total hip arthroplasty without prior lumbar arthrodesis: a systematic review and meta-analysis

Abstract

Purpose The number of patients undergoing total hip arthroplasty (THA) surgery after previous lumbar arthrodesis (LA) is rising. Literature suggests that LA may significantly impact pelvic biomechanics and potentially compromise the success of prosthetic hip replacement. This study aims to evaluate complication rates, dislocation rates, and revision rates in patients with prior LA undergoing THA surgery compared to those undergoing THA surgery without prior LA. Methods A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A PICOS template was developed to ensure a structured approach. The search for relevant studies was performed across five databases, including Pubmed, Scopus, Embase, Medline, and Cochrane. The selected articles were evaluated based on the Levels of Evidence (LoE) criteria. The Coleman Methodology Score (mCMS) was employed to analyze the retrospective studies. This systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that allowed for a meta-analysis performed using R software, a p < 0.05 was considered statistically significant. Results The final analysis included seventeen studies comprising a total of 3,139,164 cases of THA. Among these cases, 3,081,137 underwent THA surgery alone, while 58,027 patients underwent THA with a previous LA. The study investigated various factors, including dislocation rates, revision rates, and complication, as well as the surgical approach and type of implant used, for both the THA-only group and the group of patients who underwent THA with prior LA. The analysis revealed a statistically significant difference (p < 0.05) for all variables studied, favoring the group of patients who underwent THA alone without prior LA. Conclusions This systematic review and meta-analysis demonstrated a statistically significant superiority in all analyzed outcomes for patients who underwent THA-only without prior LA. Specifically, patients with isolated THA implants experienced significantly lower incidences of THA dislocation, wound complications, periprosthetic joint infection, revision, and mechanical complications. Level of evidence Level IV.

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

“…Examine the pelvis for alignment irregularities that could affect the hip replacement and its position, whether anteverted or retroverted in the sagittal plane. Observing the patient’s gait may help identify compensatory movements influenced by lumbar issues [ 6 , 9 , 10 , 13 ].…”

“…Detect that there are no peripheral vasculo-nervous deficits. Perform the Trendelenburg test and inquire about and assess pain, distinguishing between lumbar-related discomfort and potential hip pain [ 9 , 10 ]. Assess the patient’s overall status and functional demands, considering daily activities and mobility in the context of LA and the potential problems this may bring in a THA surgery [ 10 , 13 ].…”

“…Furthermore, it includes an assessment of lower limb mechanics, evaluating how limitations in the lumbar spine might affect leg function and gait [ 6 , 7 , 9 , 10 , 13 ]. Examine the alignment and ROM of the knees and ankles, as compensatory mechanisms due to restricted lumbar movement may lead to abnormal stress and potential pathology in these joints.…”

“…Examine the alignment and ROM of the knees and ankles, as compensatory mechanisms due to restricted lumbar movement may lead to abnormal stress and potential pathology in these joints. Assess muscle strength and flexibility in the lower limbs, particularly the quadriceps, hamstrings, and calf muscles, as imbalances can influence overall mobility and stability [ 9 , 10 , 13 ].…”

“…Patients with prior spinal stabilization have a higher risk of dislocation and revision after THA surgery compared to those without prior LA [ 2 , 3 , 6 , 7 , 8 , 9 , 10 ]. LA, the fusion of the lumbar spine, may modify the biomechanics of the pelvis and spine, especially during postural changes [ 11 , 12 ].…”