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Complication Rates of Hip-Spine Syndrome Patients With Total Hip Arthroplasty and Lumbar Spine Surgery
Raheyma N Siddiqui1, Jakub K Gocal, Michelle R Shimizu
1From the Stritch School of Medicine (Siddiqui, Gocal, Dr. Shimizu), Loyola University Chicago, Maywood IL, and the Department of Orthopaedic Surgery and Rehabilitation (Dr. Schmitt, Dr. Brown), Loyola University Medical Center, Maywood IL.
Introduction:
Hip-spine syndrome, defined as the coexistence of degeneration in the hip and lumbar spine, is a common disorder in the elderly patient population. There is much debate on whether the hip or lumbar spine should be prioritized for surgical intervention. Although lumbar spine surgery (LSS) and total hip arthroplasty (THA) are well-investigated with proven success, there is limited knowledge on whether the order of surgical intervention influences outcomes. This study investigates dislocation rates and complications in hip-spine syndrome patients with a history of LSS and the impact of surgical sequence and surgical approach on dislocation risk.
Methods:
A retrospective chart review identified patients with hip-spine syndrome who underwent THA with or without LSS over a 20-year period. THA approach (anterior vs posterior), date of THA and LSS, postoperative venous thromboembolism, and dislocation rates, readmissions, and revision surgeries within a year of both THA and LSS were collected. Data were analyzed to determine the association between prior LSS and dislocation, as well as for covariates, including age, sex, race, CCI, and smoking status.
Results:
In our analysis of 419 patients, logistic regression showed LSS before THA (6.2%) was associated with 8.18 times (P = 0.012) increased odds of dislocation when compared with patients who underwent only THA (0.9%) and THA before LSS (0%). In the THA-only group, the anterior and posterior approaches resulted in a dislocation rate of 0.7% (1/153) and 1.0% (2/193), respectively. In patients who underwent LSS before THA, the anterior and posterior approaches resulted in dislocation rates of 4.3% (1/23) and 8.0% (2/25), respectively. Venous thromboembolism complications were only present in the THA-only group. No relationship was found between dislocation occurrence and age, sex, race, CCI, and smoking status across three cohorts.
Conclusion:
This study suggests in patients with hip-spine syndrome, there is an increased risk of dislocation in patients who undergo LSS before THA compared with those who undergo only THA or THA before LSS. The results of this study are comparable with prior literature analyzing the impact of a history of LSS and suggest the need for comprehensive preoperative planning in patients with lumbar pathologies.