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The Impact of Previous Lumbar Spine Surgery on Primary Total Hip Arthroplasty: Minimum 2-Year Outcomes Controlling
Roger Quesada-Jimenez1, Andrew R Schab1, Ady H Kahana-Rojkind1
1American Hip Institute Research Foundation, Chicago, Illinois.
Background:
Prior lumbar spine surgery (LSS) can limit spine mobility, potentially increasing hip motion requirements. This study aimed to assess the influence of LSS on primary total hip arthroplasty (THA).
Methods:
Retrospective analysis was conducted on patients who underwent THA with prior LSS. Included patients had completed patient-reported outcomes (PROs) and visual analog scale for pain questionnaires or had a documented revision surgery with a minimum 2-year follow-up. Patients were propensity matched to a benchmark control group of patients who did not have previous spine pathology in a 1:3 ratio, controlling for age at surgery, surgical approach, use of advanced technology, sex, and body mass index. The analysis included comparisons of hip arthroplasty thresholds and complications. Subanalyses based on the type of lumbar surgery and type of approach were also conducted.
Results:
There were 244 hips included in the study. The LSS group reported comparatively lower postoperative PRO scores. However, the LSS group experienced a similar magnitude of improvement. The LSS group met patient acceptable symptom state threshold for Forgotten Joint Score at a significantly lower rate. The LSS had a higher frequency of complications leading to revision THA with a relative risk of 24 and a relative risk of 20.8 for revision THA due to instability. Comparing patients by type of LSS, PROs, the percentage of patients reaching hip arthroplasty thresholds, and the revision THA rates were similar. There was no difference in complications considering the type of approach.
Conclusions:
Patients who had prior LSS who underwent primary THA demonstrated equivalent improvements in PROs, but achieved lower overall postoperative scores and met hip arthroplasty thresholds at lower rates. Furthermore, patients undergoing primary THA with prior LSS had a higher risk of complications leading to revision surgery, including a 24-fold relative risk for complications leading to revision and a 20.8-fold relative risk of revision due to instability.
