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Abnormally High Dislocation Rates of Total Hip Arthroplasty After Spinal Deformity Surgery
Nicholas A Bedard1, Christopher T Martin1, Sean E Slaven1
1Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Insights
Concurrent spinopelvic fusion and total hip arthroplasty (THA) occurs in 4.6% of patients. THA dislocation risk is significantly higher in patients with concurrent spinopelvic fusion, reaching 20% institutionally and 8.3% nationally.
Area of Science:
- Orthopedic surgery
- Spine surgery
- Arthroplasty
Background:
- Concurrent spinopelvic fusion and total hip arthroplasty (THA) is uncommon.
- Understanding the prevalence and risks associated with this combined procedure is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of concurrent spinopelvic fusion and THA.
- To identify the risk of THA dislocation in patients undergoing concurrent spinopelvic fusion.
Main Methods:
- Retrospective review of institutional spinal deformity patient database.
- Analysis of the Humana Inc. national insurance claims database.
- Identification of patients with concurrent THA and spinopelvic fusion and assessment of dislocation rates.
Main Results:
- Prevalence of concurrent THA in spinopelvic fusion patients was 4.6% (institutional and national).
- Prevalence of concurrent spinopelvic fusion in primary THA patients was 0.1%.
- THA dislocation rates were 20.0% (institutional) and 8.3% (national) for concurrent procedures, versus 2.9% for THA without spinopelvic fusion.
Conclusions:
- Concurrent spinopelvic fusion and THA is rare but associated with a significantly elevated risk of THA dislocation.
- The high dislocation rate highlights potential biomechanical challenges and the need for careful patient selection and surgical planning.
Background:
The purpose of this study was to determine the prevalence of concurrent spinopelvic fusion and THA and identify the risk of THA dislocation in patients with concurrent spinopelvic fusion.
Methods:
We retrospectively reviewed an institutional database of spinal deformity patients and the Humana Inc data set to identify patients with concurrent THA and spinopelvic fusion. The prevalence of concurrent THA and spinopelvic fusion was identified, as was the risk of dislocation for all cohorts.
Results:
Of 328 patients with spinopelvic fusions at our institution, 15 patients (4.6%) were found to have concurrent THA. Similarly, within the Humana database among 1049 patients with spinopelvic fusion, 4.6% had a concurrent THA. Among the 58,692 THA patients identified, only 0.1% had a concurrent spinopelvic fusion. A THA dislocation was observed in 3 of 15 patients (20.0%) and 3 of 18 THA (16.7%) within our institutional review. Within the Humana database, 8.3% of patients with THA and spinopelvic fusion went on to have a dislocation of their THA compared to 2.9% of patients with THA and no history of spinopelvic fusion (relative risk: 2.9 [1.2-7.6]).
Conclusion:
Among patients with spinopelvic fusion, the prevalence of concurrent THA is 4.6%, and among primary THA patients, the prevalence of concurrent spinopelvic fusion is 0.1%. An alarmingly high THA dislocation rate has been demonstrated among THA patients with concurrent spinopelvic fusion at our institution (20%) and within a large national database (8.3%).
