Timing of total hip replacement affects spine surgery outcomes

Alan Condon -  

Patients who undergo total hip replacement have an increased rate of lumbar-related complications compared with those who do not undergo hip replacements and those who undergo the procedure before lumbar spinal fusion, according to a study published in Clinical Spine Surgery in March.

Five notes:

1. The study analyzed patients who underwent lumbar spinal fusion within the PearlDiver Humana database from 2010-18.

2. Patients were divided into four groups: those who underwent lumbar spinal fusion without hip replacement; those who had hip replacement at least two years before lumbar spinal fusion; those who had a hip replacement in the two years before lumbar spinal fusion; and those who had a hip replacement after lumbar spinal fusion.

3. Researchers studied lumbar-specific outcomes, including pseudarthrosis, revision, mechanical failure and adjacent segment disease — a widely known potential complication post-spinal fusion — as well as systemic complications. Complication rates between all groups were evaluated using univariate and multivariate logistic regression analysis to control for age, sex, and Charlson Comorbidity Index, which predicts the 10-year mortality for patients with a range of comorbidities.

4. Patients who had total hip replacement after lumbar spinal fusion had a higher rate of adjacent segment disease compared to patients who underwent lumbar spinal fusion without a total hip replacement.

5. When compared with all patients who underwent total hip replacement before lumbar spinal fusion, those who had a hip replacement after lumbar spinal fusion had an increased risk of adjacent segment disease.

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