Related Experiment Video
Updated: Dec 3, 2025
Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
Comparable dislocation and revision rates for patients undergoing total hip arthroplasty with subsequent or prior
James Randolph Onggo1,2, Mithun Nambiar3,4, Jason Derry Onggo3,5
1Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia. jamesonggo1993@hotmail.com.
Insights
The surgical order of lumbar spinal fusion (LSF) and total hip arthroplasty (THA) does not impact hip dislocation or revision rates. LSF is a risk factor for THA complications, irrespective of the sequence of these procedures.
Area of Science:
- Orthopedic Surgery
- Spinal Surgery
- Arthroplasty
Background:
- Lumbar spinal fusion (LSF) and total hip arthroplasty (THA) are associated with hip dislocation and revision complications.
- The optimal surgical sequence to minimize these risks remains unclear.
Purpose of the Study:
- To determine if the sequence of LSF and THA influences the rates of hip dislocation and revision.
- To analyze the impact of performing THA before or after LSF on patient outcomes.
Main Methods:
- A comprehensive meta-analysis was performed using data from multiple databases (PubMed, OVID, EMBASE, Medline).
- Literature published up to May 27, 2020, meeting specific inclusion criteria was analyzed.
- An inverse variance statistical model was employed for data analysis.
Main Results:
- The study included 25,558 patients with subsequent LSF and 43,880 patients with prior LSF THA.
- No statistically significant differences were found in all-cause revisions, dislocation, or aseptic loosening between the two groups.
- Odds ratios (OR) for revisions, dislocation, and aseptic loosening were 0.86, 0.82, and 1.14, respectively.
Conclusions:
- Lumbar spinal fusion is a persistent risk factor for total hip arthroplasty dislocation and revision, regardless of surgical timing.
- Patients undergoing THA with a history of or planned LSF require careful preoperative assessment and potentially modified surgical techniques.
Background:
There is a known correlation between the procedures of lumbar spinal fusion (LSF), total hip arthroplasty (THA) and the complication of hip dislocation and revision occurring in patients. However there is no consensus as to whether the risk of this complication is higher if THA is performed before or after LSF. This meta-analysis aims to determine the influence of surgical sequence of lumbar spinal fusion and total hip arthroplasty on the rates of hip dislocation and revisions.
Methods:
A meta-analysis was conducted with a multi-database search (PubMed, OVID, EMBASE, Medline) according to PRISMA guidelines on 27th May 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model.
Findings:
A total of 25,558 subsequent LSF and 43,880 prior LSF THA patients were included in this study. There was no statistically significant difference in all-cause revisions (OR = 0.86, 95%CI: 0.48-1.54, p = 0.61), dislocation (OR = 0.82, 95%CI: 0.25-2.72, p = 0.75) or aseptic loosening (OR = 1.14, 95%CI: 0.94-1.38, p = 0.17) when comparing patients receiving LSF subsequent versus prior to THA.
Conclusion:
Lumbar spinal fusion remains a risk factor for dislocation and revision of total hip arthroplasties regardless of whether it is performed prior to or after THA. Further preoperative assessment and altered surgical technique may be required in patients having THA who have previously undergone or are likely to undergo LSF in the future.
Evidence Level:
Level II, Meta-analysis of homogeneous studies.
