The Hip-Spine Challenge

Abstract

The proper diagnosis and treatment of patients with concurrent hip and spine pathological processes can be challenging because of the substantial overlap in symptomatology.There is no consensus on which pathological condition should be addressed first.Factors such as advanced spinal degeneration, deformity, and prior fusion alter the biomechanics of the spinopelvic unit. Attention should be paid to recognizing these issues during the work-up for a total hip arthroplasty as they can result in an increased risk of dislocation.In patients with concurrent spine and hip degeneration, the surgeon must pay close attention to appropriate implant positioning and have consideration for implants with enhanced stability to minimize the risk of dislocation.A proper understanding of sagittal balance and restoration of this balance is integral to improving patient outcomes following spinal surgery.The advent of new imaging modalities, increased awareness of spinopelvic mobility, as well as a better understanding of sagittal alignment will hopefully improve our treatment of patients with hip-spine syndrome.

Total hip arthroplasty has higher complication rates in stiff spine patients: a systematic review and network meta-analysis

“…Further development of a functional assessment tool to validate the treatment algorithms may lead to improved evidence-based practices for hip and spine surgeons. A thorough discussion with the patients regarding expectations, timing of surgery, preoperative planning including radiographic assessments, explanation of the increased risk of postoperative complications, and management strategies should occur preoperatively [ 50 ]. Further research should be done to better understand the spinopelvic relationship among the stiff spine population and with more randomized controlled study designs with this issue.…”

“…Further research should be done to better understand the spinopelvic relationship among the stiff spine population and with more randomized controlled study designs with this issue. Technology improvement including intraoperative imaging and the robotic or computer-assisted surgery may improve the accuracy of acetabular component placement [ 50 – 52 ]. Operators should be cautious when performing THAs on long spinal fusion patients.…”

Hip replacement improves lumbar flexibility and intervertebral disc height — a prospective observational investigation with standing and sitting assessment of patients undergoing total hip arthroplasty

“…dislocation [11,12]. Due to the close relation of the hip and spine, there is an emerging interest in concepts of treating patients with concurrent hip and spine pathology [13]. The influence of the hip and especially THA on the lumbar spine and its sagittal alignment remains widely unknown.…”

Lower Extremity Osteoarthritis: A Risk Factor for Mental Health Disorders, Prolonged Opioid Use, and Increased Resource Utilization After Single-Level Lumbar Spinal Fusion

“…Patients undergoing THA followed by lumbar fusion have been shown to have higher complication rates, revision surgery rates, postoperative pain scores, and narcotic usage than those not undergoing subsequent fusion. 12 , 13 Similarly, patients undergoing THA after lumbar fusion have been shown to have decreased satisfaction, less improvement in overall pain, and worse quality of life than those without previous fusion. 13 , 14 Direct comparison of these two groups has shown that patients undergoing THA before lumbar fusion are at an increased risk of postoperative dislocation, infection, revision surgery, and prolonged opioid use compared with those undergoing THA after lumbar fusion.…”

“… 12 , 13 Similarly, patients undergoing THA after lumbar fusion have been shown to have decreased satisfaction, less improvement in overall pain, and worse quality of life than those without previous fusion. 13 , 14 Direct comparison of these two groups has shown that patients undergoing THA before lumbar fusion are at an increased risk of postoperative dislocation, infection, revision surgery, and prolonged opioid use compared with those undergoing THA after lumbar fusion. 15 By contrast, fewer studies have evaluated whether lower extremity arthritis affects the results of lumbar spine surgery.…”