TY - JOUR
T1 - Prosthetic Dislocation and Revision After Primary Total Hip Arthroplasty in Lumbar Fusion Patients
T2 - A Propensity Score Matched-Pair Analysis
AU - Perfetti, Dean C.
AU - Schwarzkopf, Ran
AU - Buckland, Aaron J.
AU - Paulino, Carl B.
AU - Vigdorchik, Jonathan M.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2017/5
Y1 - 2017/5
N2 - Background Lumbar-pelvic fusion reduces the variation in pelvic tilt in functional situations by reducing lumbar spine flexibility, which is thought to be important in maintaining stability of a total hip arthroplasty (THA). We compared dislocation and revision rates for patients with lumbar fusion and subsequent THA to a matched comparison cohort with hip and spine degenerative changes undergoing only THA. Methods We identified patients in New York State who underwent primary elective lumbar fusion for degenerative disc disease pathology and subsequent THA between January 2005 and December 2012. A propensity score match was performed to compare 934 patients with prior lumbar fusion to 934 patients with only THA according to age, gender, race, Deyo comorbidity score, year of surgery, and surgeon volume. Revision and dislocation rates were assessed at 3, 6, and 12 months post-THA. Results At 12 months, patients with prior lumbar fusion had significantly increased rates of THA dislocation (control: 0.4%; fusion: 3.0%; P < .001) and revision (control: 0.9%; fusion: 3.9%; P < .001). At 12 months, fusion patients were 7.19 times more likely to dislocate their THA (P < .001) and 4.64 times more likely to undergo revision (P < .001). Conclusion Patients undergoing lumbar fusion and subsequent THA have significantly higher risks of dislocation and revision of their hip arthroplasty than a matched cohort of patients with similar hip and spine pathology but only undergoing THA. During preoperative consultation for patients with prior lumbar fusion, orthopedic surgeons must educate the patient and family about the increased risk of dislocation and revision.
AB - Background Lumbar-pelvic fusion reduces the variation in pelvic tilt in functional situations by reducing lumbar spine flexibility, which is thought to be important in maintaining stability of a total hip arthroplasty (THA). We compared dislocation and revision rates for patients with lumbar fusion and subsequent THA to a matched comparison cohort with hip and spine degenerative changes undergoing only THA. Methods We identified patients in New York State who underwent primary elective lumbar fusion for degenerative disc disease pathology and subsequent THA between January 2005 and December 2012. A propensity score match was performed to compare 934 patients with prior lumbar fusion to 934 patients with only THA according to age, gender, race, Deyo comorbidity score, year of surgery, and surgeon volume. Revision and dislocation rates were assessed at 3, 6, and 12 months post-THA. Results At 12 months, patients with prior lumbar fusion had significantly increased rates of THA dislocation (control: 0.4%; fusion: 3.0%; P < .001) and revision (control: 0.9%; fusion: 3.9%; P < .001). At 12 months, fusion patients were 7.19 times more likely to dislocate their THA (P < .001) and 4.64 times more likely to undergo revision (P < .001). Conclusion Patients undergoing lumbar fusion and subsequent THA have significantly higher risks of dislocation and revision of their hip arthroplasty than a matched cohort of patients with similar hip and spine pathology but only undergoing THA. During preoperative consultation for patients with prior lumbar fusion, orthopedic surgeons must educate the patient and family about the increased risk of dislocation and revision.
KW - degenerative spine disease
KW - dislocation
KW - instability
KW - lumbar fusion
KW - revision
KW - total hip arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85008186475&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2016.11.029
DO - 10.1016/j.arth.2016.11.029
M3 - Article
C2 - 27998660
AN - SCOPUS:85008186475
SN - 0883-5403
VL - 32
SP - 1635-1640.e1
JO - The Journal of Arthroplasty
JF - The Journal of Arthroplasty
IS - 5
ER -