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Timing of Lumbar Spinal Fusion Relative to Revision Total Hip Arthroplasty Affects Complications

Key findings

  • This retrospective study compared 328 patients who underwent lumbar spinal fusion (LSF) six months to a year before revision total hip arthroplasty (THA) and 177 patients who had revision THA one to two years before LSF
  • Cumulative rates of dislocation and re-revision were higher for patients who underwent LSF before revision THA than for patients who had LSF after revision THA
  • The greater the interval between revision THA and subsequent LSF, the lower the risk for dislocation and re-revision
  • The inferior outcomes of LSF followed by THA are likely related to altered spinal–pelvic biomechanics, so surgeons should consider a comprehensive evaluation of pelvic parameters during standing and sitting for patients who need revision THA after LSF

As the U.S. population ages, an increasing number of patients are undergoing both lumbar spinal fusion (LSF) and total hip arthroplasty (THA). A previous study showed the temporal relationship of LSF relative to primary THA makes a difference: patients were at increased risk of postoperative dislocation and re-revision if they had previously undergone LSF.

Now, researchers at Massachusetts General Hospital have found similar results for patients undergoing revision THA. Christian Klemt, PhD, research fellow, Young-Min Kwon, MD, PhD, director of the Bioengineering Laboratory and program director of the Adult Reconstructive Surgery Fellowship Program, and their Laboratory colleagues in the Department of Orthopaedic Surgery, published their findings in the Journal of the American Academy of Orthopaedic Surgeons.

Study Methods

The team reviewed 505 patients:

  • 328 who underwent LSF, then revision THA (LSF-THA); 58% had revision THA within one year after LSF, and 42% had revision THA within six months after
  • 177 who underwent revision THA followed by LSF (THA-LSF); 40% had LSF within one year after revision THA, and 60% had LSF one to two years later

All LSF procedures were instrumented and were performed for degenerative lumbar spinal stenosis with spondylolisthesis. The two groups were similar with regard to demographics, medical comorbidities and indications for revision.

Overall Complication Rates

Cumulative dislocation rates:

  • 1-year follow-up: 6.7% in the LSF-THA group vs. 5.1% in the THA-LSF group (P<0.01)
  • 2-year: 8.2% vs. 6.3% (P<0.01)
  • 3-year: 10.4% vs. 7.5% (P<0.01)

Cumulative re-revision rates:

  • 1-year: 8.5% vs. 7.0% (P=0.02)
  • 2-year: 10.7% vs. 8.6% (P=0.01)
  • 3-year: 13.9% vs. 10.0% (P<0.01)

Subgroup Analysis

The greater the interval between revision THA and subsequent LSF, the lower the risk of postoperative complications, including dislocation or re-revision.

Guidance for Surgeons

As both revision THA and LSF are often elective surgeries based on clinical indications, when possible, their timing should be adjusted to optimize patient outcomes. This is especially important for revision THA due to its complexity, expense and burden to patients.

The inferior outcomes of LSF followed by revision THA are likely to be related to alterations in spinal–pelvic biomechanics. To identify patients who have lost normal compensatory pelvic version and tilt, surgeons should consider a comprehensive evaluation of pelvic parameters during standing and sitting, possibly through preoperative sagittal spine radiographs, for patients who require revision THA after LSF.

Learn more about the Bioengineering Lab at Mass General

Refer a patient to the Mass General Center for Hip & Knee Replacement

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