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Parihar A, Deckard ER, Buller LT, Meneghini RM. Instability in Patients With Lumbar Spine Disease Undergoing Posterior Approach and Lateral Approach Primary Total Hip Arthroplasty. J Am Acad Orthop Surg 2024; 32:e396-e404. [PMID: 38175997 DOI: 10.5435/jaaos-d-23-00885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/18/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Dislocation rates in patients who have fixed spinopelvic motion have been reported up to 20%. Few studies have directly compared dislocation rates in patients who have spine pathology undergoing total hip arthroplasty (THA) through different surgical approaches. This study compared postoperative dislocation rates in patients who had lumbar spine disease and underwent primary THA using a posterior or direct lateral approach. METHODS Between 2011 and 2017, consecutive cohorts of primary THAs were retrospectively reviewed. One surgeon routinely used a posterior approach, while the other used a direct lateral approach. Chart and radiographic review were conducted to identify patients who had lumbar spine disease. Dislocations among cohorts with and without lumbar spine disease were compared by posterior and direct lateral approaches. RESULTS The overall dislocation rate was 1.3% (15/1,198). The top four predictors of dislocation were presence of lumbar spine disease (odds ratio [OR] 5.0; P = 0.014), posterior surgical approach (OR, 6.5; P = 0.074), cases performed for fracture (OR, 4.4; P = 0.035), and women (OR, 4.6; P = 0.050). Dislocation rates among direct lateral approach patients who had lumbar spine pathology were significantly lower than posterior approach patients who had lumbar spine pathology (0.0% versus 3.6%; P = 0.011). DISCUSSION Although dislocation rates were low in both groups, study results suggest that a direct lateral approach for primary THA may reduce postoperative dislocations for patients who have limited spinopelvic motion due to lumbar spine pathology. Furthermore, surgeons using the posterior approach might consider optimizing the femoral head to acetabular cup ratio in patients who have lumbar spine disease.
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Affiliation(s)
- Amrit Parihar
- From the Department of Orthopaedic Surgery, Indiana University School of Medicine (Parihar, Buller, and Meneghini), and the Indiana Joint Replacement Institute, Indianapolis, Indiana (Deckard, and Meneghini)
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2
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Welling S, Smith S, Yoo J, Philipp T, Mildren M, Kagan R. Is Timing of Total Hip Arthroplasty and Lumbar Spine Fusion Associated With Risk of Hip Dislocation? Arthroplast Today 2023; 23:101202. [PMID: 37753220 PMCID: PMC10518672 DOI: 10.1016/j.artd.2023.101202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/20/2023] [Indexed: 09/28/2023] Open
Abstract
Background In patients with concomitant hip and lumbar spine disease, the question of which surgery-total hip arthroplasty (THA) or lumbar spine fusion (LSF)-to address first has not been adequately answered. We aimed to evaluate the risk of dislocation after THA in patients with LSF first or after THA. Methods Retrospective review utilizing the PearlDiver database querying Current Procedural Terminology codes for LSF in the year prior (LSF first) or in the year after primary or revision THA (THA first). International Classification of Disease codes identified postoperative hip dislocation as our primary outcome variable. Demographic data collected included age, sex, and obesity. Dislocation rates were described as a proportion of the cohort and compared with chi-square tests. Results We identified 280,857 primary THA and 42,314 revision THA cases from 2012-2019. Of these, 2090 underwent primary THA and LSF, and 283 underwent revision THA and LSF within a year of each procedure. No differences in age, sex, or obesity between groups were noted. No difference in rate of all-time dislocation for primary THA was noted for the LSF first 51/1429 (3.6%) compared to the THA first 30/661 (4.0%) groups (P = .34), or for revision THA with LSF first 48/204 (23.5%) compared to THA first 27/117 (23.1%) groups (P = 1.0). Conclusions There was no difference in the risk of dislocation after primary or revision THA if LSF occurred prior to or after the THA. These findings can help surgeons as they counsel patients with concomitant lumbar spine and hip degeneration.
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Affiliation(s)
- Sebastian Welling
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Spencer Smith
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Travis Philipp
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Mark Mildren
- Slocum Center for Orthopedics and Sports Medicine, Eugene, OR, USA
| | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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3
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Sirignano M, Nessler JM, Rhea EB, Ong KL, Watson H, Yakkanti MR, Malkani AL. "Incidence of Instability Following Primary Total Hip Arthroplasty Continues to Decline in the Medicare Population". J Arthroplasty 2023:S0883-5403(23)00391-1. [PMID: 37088227 DOI: 10.1016/j.arth.2023.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Instability has been the primary cause of failure following primary total hip arthroplasty (THA) leading to revision hip surgery. The purpose of this study was to determine if instability rates have further declined following advances in primary THA including dual mobility articulations, direct anterior approaches, advanced technologies, and improved knowledge of the hip-spine relationships. METHODS Using the 5% Medicare Part B claims data from 1999 to 2019, we identified 81,573 patients who underwent primary THA for osteoarthritis. Patients who experienced instability at 3 months, 6 months, 1 year, and 2 years were identified. Multivariate cox regression analyses evaluated the effect of patient and procedure characteristics on the risk for instability. RESULTS Instability at 1 year following primary THA declined from approximately 4% in 2000 to 2.3% in 2010 and 1.6% in 2018. The leading cause of revision surgery was infection (18.6%), followed by peri-prosthetic fracture (14%), mechanical loosening (11.5%), and instability (9.4%). High risk groups for instability continue to include increased age, higher Charlson index, obesity, lumbar spine pathology, and neurocognitive disorders. CONCLUSION Instability is no longer the leading etiology of failure following primary THA with a decline of approximately 40% over the past decade. Infection, periprosthetic fracture, mechanical loosening, and then instability are now the leading causes of failure. Multiple factors may play a role in the decline of instability including increased use of dual mobility articulations, direct anterior approaches, improved knowledge of the hip-spine relationships, and use of advanced technologies.
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Affiliation(s)
- Michael Sirignano
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Joseph M Nessler
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Evan B Rhea
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Kevin L Ong
- Exponent Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104, USA
| | - Heather Watson
- Exponent Inc., 15375 SE 30th Place, Suite 250, Bellevue, WA 98007, USA
| | | | - Arthur L Malkani
- University of Louisville, Dept. of Orthopedic Surgery, Adult Reconstruction Program, 550 South Jackson Street, Louisville, KY 40202, USA.
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Pitz-Gonçalves LI, Deckard ER, Meneghini RM. Large Femoral Heads and Select Dual-Mobility Bearings Are Associated With Reduced Instability in Contemporary Posterior Approach Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00119-5. [PMID: 36791889 DOI: 10.1016/j.arth.2023.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Postoperative dislocation is considered the main drawback of posterior approach total hip arthroplasty (THA). Thinner highly cross-linked polyethylene and dual-mobility bearings allow maximizing femoral head diameter per a given cup size. This study evaluated dislocation rates as large femoral head bearings were introduced into a practice over an 11-year period. METHODS A total of 1,511 consecutive primary THAs were retrospectively reviewed. Demographics, implant sizes, femoral head-acetabular cup ratio, and dislocation status were collected from the electronic medical record. Data were evaluated using time series analysis techniques as larger femoral heads, thinner polyethylene liners, and dual-mobility bearings were introduced. The cohort was 57% women with mean age and body mass index of 62 years (range, 13 to 93) and 31 kg/m2 (range, 13 to 54), respectively. RESULTS The overall dislocation rate was 0.98%. Use of femoral head sizes ≥ 40 millimeters increased from 4% in the years 2010 to 2016 to 51% in the years 2017 to 2021, correlating with a 50% reduction in dislocation rate from 1.4% to 0.7% (P = .279). Also, no dislocations occurred in patients who had dual-mobility bearings or ≥ 40-millimeter femoral heads (P = .007). Twelve of 14 dislocations occurred in cases with head-cup ratio < 0.7 (P = .013). Thirteen of 14 dislocations were in women (P = .005). CONCLUSION Maximizing the femoral head diameter per given cup size correlated with a decrease in dislocation rate in modern posterior approach THA. Furthermore, these results suggest that dual-mobility articulations should be reserved for high-risk patients or patients in whom a 40-millimeter femoral head is not possible. LEVEL OF EVIDENCE IV-consecutive case series; no control group.
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Affiliation(s)
- Lauren I Pitz-Gonçalves
- Department of Orthopaedic Surgery and Rehabilitation Services, The University of Chicago, Chicago, Illinois
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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5
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Schmidt-Braekling T, Coyle MJ, Dobransky J, Kreviazuk C, Gofton W, Phan P, Beaulé PE, Grammatopoulos G. Spinal pathology and outcome post-THA: does segment of arthrodesis matter? Arch Orthop Trauma Surg 2022; 142:3477-3487. [PMID: 34677633 DOI: 10.1007/s00402-021-04220-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The presence of lumbar spine arthrodesis (SA) is associated with abnormal spinopelvic characteristics and inferior outcome post total hip arthroplasty (THA). However, whether patients with upper segment SA are also at increased risk of complications is unknown. This study aims to (1) determine if upper segment SA is associated with inferior THA outcomes; (2) assess spino-pelvic characteristics; and (3) test whether static or dynamic spinopelvic characteristics correlate with outcome post-THA. MATERIALS AND METHODS In this retrospective, case-matched, cohort study from a tertiary referral centre, 40 patients (59 hips) that had undergone both THA and any level of spinal arthrodesis (49 THA-Lumb and 10 THA-Cerv) were compared with 41 patients (59 hips) who had THA-only without known spinal pathology. Spino-pelvic characteristics [including severity of Degenerative-Disc-Disease (DDD); spinal balance and stiffness] and outcome, including patient reported outcome measures (PROMs), at minimum of 1-year post-THA were assessed. RESULTS THA-Lumb and THA-Cerv groups had greater number of complications and inferior hip and spinal PROMs compared to THA-Only (p < 0.001). Similar spinopelvic characteristics were seen between the THA-Cerv and THA-Lumb, which were significantly different to the THA-only group. The presence of DDD and unbalanced or stiff spine was associated with increased dislocation and inferior PROMs in the whole cohort. CONCLUSIONS THA in the presence of SA, regardless of level, is associated with inferior outcomes and an increased risk for dislocation. The presence of a SA is associated with increased risk of adverse spinopelvic characteristics. Such characteristics were strongly associated with increased dislocation-risk and inferior PROMs. It is likely that these adverse characteristics are the most important adverse predictor, rather than segment of SA per se.
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Affiliation(s)
- Tom Schmidt-Braekling
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada.,Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Matthew J Coyle
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Johanna Dobransky
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Wade Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada.
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6
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Guan H, Xu C, Fu J, Yang X, Zhang Y, Chen J. Ankylosing Spondylitis Patients Have Lower Risk of Dislocation Following Total Hip Arthroplasty Compared with Patients Undergoing Lumbar Spinal Fusion Surgery. Int J Gen Med 2022; 15:6573-6582. [PMID: 35978732 PMCID: PMC9377400 DOI: 10.2147/ijgm.s373432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients undergoing lumbar spinal fusion (LSF) surgery and patients with ankylosing spondylitis (AS) have concomitant pathology of hip and lumbosacral spine. The purpose of our study is to compare the dislocation rate following total hip arthroplasty (THA) between patients with LSF and AS and reveal the differences of lumbar fusion secondary to LSF and AS. Patients and methods Fifty-nine patients (73 hips) were included in Group LSF and every patient was matched with two patients in Group AS. Follow-ups were conducted for information of surgical prognosis and dislocation events following THA. Multiple anatomic parameters were measured on preoperative and postoperative radiological images. Results The dislocation rate of patients in Group AS (0.68%) was obviously lower than that of patients in Group LSF (4.11%) and the hazard ratio of dislocation events following THA reached 6.1. Considering the low calculated power (1-β, 0.24), we supposed insufficient statistical evidence (p=0.118) could be attributed to small sample size. Postoperative hip flexion range of motion (ROM) in Group AS (102.1°±24.5°) was significantly lower than that in Group LSF (117.4°±14.2°) (p<0.0005). Postoperative flexion ROM of lumbar was also significantly lower in Group AS (p<0.001). There was no significant difference between two groups concerning postoperative acetabular inclination (p=0.988) and anteversion (p=0.25). However, patients in Group AS had a significantly lower sacral slope (p=0.025) and higher pelvic tilt (p<0.0005) than patients in Group LSF after THA. Conclusion Patients with AS have a lower risk of dislocation after THA compared with patients undergoing LSF. The lower risk is significantly relevant to severer stiffness and lower mobility along the spine-pelvis--hip axis in AS patients after THA. Acetabular orientation has no significant effect on the difference of dislocation rate between patients with LSF and AS.
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Affiliation(s)
- Haitao Guan
- School of Medicine, Nankai University, Tianjin, People's Republic of China.,Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Chi Xu
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Fu
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xue Yang
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Jiying Chen
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
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7
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Mihalko WM, Urish K, Haider H. Optimal designs and surgical technique for hip and knee joint replacement: The best is yet to come! J Orthop Res 2021; 39:1851-1859. [PMID: 33002224 DOI: 10.1002/jor.24873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
Over the last three decades, there have been significant advancements in knee and hip replacement technology. The implants and the surgical technology we now have to aid in their implantation are advancing and improving functional outcomes and survivorship. Despite these advancements, there are still issues with patient satisfaction, functional limitations, and early revisions due to instability and aseptic loosening. This article reviews the state of current technology in hip and knee replacement implant design and surgical technique, and reviews some of the current implant designs and surgical technologies that may be able to solve some of the most common issues in the knee and hip replacement surgery.
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Affiliation(s)
- William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Chair Joint Graduate Program in Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kenneth Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Hani Haider
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
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8
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Di Martino A, Bordini B, Ancarani C, Viceconti M, Faldini C. Does total hip arthroplasty have a higher risk of failure in patients who undergo lumbar spinal fusion? Bone Joint J 2021; 103-B:486-491. [PMID: 33641423 DOI: 10.1302/0301-620x.103b3.bjj-2020-1209.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Total hip arthroplasty (THA) patients undergoing or having a prior lumbar spine fusion (LSF) have an increased risk of mechanical complications. The aim of this registry-based, retrospective comparative cohort study is to assess the longer term survival of THA in patients who have undergone a LSF during a 17-year period (2000 to 2017). METHODS A registry-based population study was conducted on 679 patients who underwent both THA and LSF surgeries. Patients were identified from the regional arthroplasty data base and cross linked to patients with LSF from the regional hospital discharge database between 2000 and 2017. Demographic data, diagnosis leading to primary THA, primary implant survival, perioperative complications, number and causes of failure, and patients requiring revision arthroplasty were collated and compared. For comparison, data from 67,919 primary THAs performed during the same time time period were also retrieved and analyzed. RESULTS Patients undergoing THA and LSF showed homogeneous demographic data compared to those undergoing THA alone, but a significantly lower eight-year THA implant survival (96.7 vs 96.0, p = 0.024) was observed. Moreover, THA plus LSF patients showed increased incidence of mechanical complications in the first two years after THA surgery compared to THA alone patients. CONCLUSION This registry-based population study shows that approximately 679 (1%) THA patients were subjected to LSF. Patients undergoing THA and LSF have an increased risk of mechanical complications with their THA and a slightly increased risk of revision arthroplasty. Cite this article: Bone Joint J 2021;103-B(3):486-491.
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Affiliation(s)
- Alberto Di Martino
- First Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristina Ancarani
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Viceconti
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Cesare Faldini
- First Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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9
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Vajapey SP, Fideler KL, Lynch D, Li M. Use of dual mobility components in total hip arthroplasty: Indications and outcomes. J Clin Orthop Trauma 2020; 11:S760-S765. [PMID: 32999552 PMCID: PMC7503159 DOI: 10.1016/j.jcot.2020.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022] Open
Abstract
Instability after total hip arthroplasty (THA) can be a problematic complication and remains one of the leading causes of revision surgery in the early post-operative period. Dual mobility (DM) implants decrease dislocation risk after THA but they come with their own set of complications. Selective use of DM implants for THA in high risk groups can confer the advantages of this construct while mitigating the risks. In this paper, we review the current literature to examine the evidence for or against use of DM implants in various clinical scenarios and provide an algorithm for when to consider using DM design construct in THA.
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Affiliation(s)
- Sravya P. Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Kathryn L. Fideler
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Daniel Lynch
- School of Medicine, The Ohio State University Wexner Medical Center, United States
| | - Mengnai Li
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States,Corresponding author. Adult Reconstructive Surgery, Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall Columbus, Ohio, 43210, United States.
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10
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Nishiyama D, Iwasaki H, Kozaki T, Taniguchi T, Taniguchi W, Harada T, Yamada H. Prediction of Pelvic Inclination in the Sitting Position after Corrective Surgery for Adult Spinal Deformity. Spine Surg Relat Res 2020; 4:242-246. [PMID: 32864491 PMCID: PMC7447342 DOI: 10.22603/ssrr.2019-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/17/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Hip dislocation rates in patients with combined total hip arthroplasty (THA) and spinal deformity fixation are significantly higher than those of THA alone. Nevertheless, there are no treatment recommendations for patients who undergo THA and require a spine deformity correction later. Methods Twenty-eight patients underwent spinal fixation surgery for adult spinal deformity. Sagittal spinopelvic alignment was analyzed on lateral radiographs taken preoperatively and postoperatively in the sitting and standing positions. Univariate linear regression analysis was conducted to identify the factors affecting the pelvic inclination in the sitting position after spinal fixation. Multiple regression analysis was conducted to determine the most efficient combination of radiographic parameters for predicting postoperative pelvic inclination while sitting. Results There were significantly weak associations between postoperative sacral slope (SS) in the sitting position and the following factors: the number of vertebral levels fused (β = 0.30, p = 0.003); the presence of sacral fixation (β = 0.22, p = 0.01); the presence of sacroiliac joint fixation (β = 0.24, p = 0.008); and preoperative SS while standing and sitting (β = 0.21, p = 0.01 and β = 0.34, p = 0.001). Postoperative lumbar lordosis (LL) while standing was strongly associated with postoperative SS in the sitting position (β = 0.67, p <.0001). The combination of postoperative LL in the standing position and preoperative SS in the sitting position was the best fit, and the adjusted R-squared was 0.82. Conclusions We devised a prediction formula for pelvic inclination while sitting after spinal fixation that has high predictability: postoperative SS while sitting = 11.7+ (0.4 × postoperative planned LL while standing) + (0.16 × preoperative SS while sitting). This study could be the basis for treatment recommendations for patients who have undergone THA and require a spine deformity correction later.
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Affiliation(s)
- Daisuke Nishiyama
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takaya Taniguchi
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Wataru Taniguchi
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Teiji Harada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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11
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Chalmers BP, Syku M, Sculco TP, Jerabek SA, Mayman DJ, Westrich GH. Dual-Mobility Constructs in Primary Total Hip Arthroplasty in High-Risk Patients With Spinal Fusions: Our Institutional Experience. Arthroplast Today 2020; 6:749-754. [PMID: 32923563 PMCID: PMC7475168 DOI: 10.1016/j.artd.2020.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/26/2020] [Accepted: 07/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background Prior spinal fusion significantly increases the risk of dislocation in patients after total hip arthroplasty (THA). Owing to these high risks, surgeons may use dual-mobility (DM) constructs in these patients to optimize hip stability. However, there is a paucity of data on the outcomes of DM constructs in patients who underwent prior spinal fusions. Methods We retrospectively identified 80 patients (86 THAs) who underwent a spinal arthrodesis and a subsequent posterior approach THA with a DM construct. The median number of levels fused was 4, with 59 (74%) patients having 2 or more levels fused; in addition, 50 (63%) patients were fused to the sacrum. Ninety percent and 55% of THAs were within the Lewinnek safe zone for inclination and anteversion, respectively. Patients were evaluated for any episode of hip instability, complications, and patient reported outcome measures. Results At 3-year mean follow-up, no patients sustained a postoperative dislocation or intraprosthetic dislocation (0%). Overall, there were 6 (7.5%) complications during the study period leading to reoperation in 3 (4%) patients, none related to the acetabular component or instability. Hip Injury and Osteoarthritis Outcome Score, Joint Replacement scores significantly improved from a mean of 50 preoperatively to 87 postoperatively (P < .001), and the Veterans Rand 12 Item Health Survey physical score improved from a mean of 31 preoperatively to 44 postoperatively (P < .001). Conclusion In a high-risk series of patients who underwent prior spinal fusion, posterolateral primary THA with a DM construct demonstrated no dislocations at mean 3-year follow-up. Although these early data are clearly encouraging, more patients with longer term follow-up are needed.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Marie Syku
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Thomas P Sculco
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Seth A Jerabek
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Wyatt MC, Kunutsor SK, Beswick AD, Whitehouse MR, Kieser DC. Outcomes following primary total hip arthroplasty with pre-existing spinal fusion surgery. Bone Joint J 2020; 102-B:664-670. [DOI: 10.1302/0301-620x.102b6.bjj-2019-1473.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims There is inconsistent evidence on whether prior spinal fusion surgery adversely impacts outcomes following total hip arthroplasty (THA). We conducted a systematic review and meta-analysis to assess the association between pre-existing spinal fusion surgery and the rate of complications following primary THA. Methods We searched MEDLINE, Embase, Web of Science, and Cochrane Library up to October 2019 for randomized controlled trials (RCTs) and observational studies comparing outcomes of dislocation, revision, or reasons for revision in patients following primary THA with or without pre-existing spinal fusion surgery. Furthermore, we compared short (two or less levels) or long (three or more levels) spinal fusions to no fusion. Summary measures of association were relative risks (RRs) (with 95% confidence intervals (CIs)). Results We identified ten articles corresponding to nine unique observational studies comprising of 1,992,366 primary THAs. No RCTs were identified. There were 32,945 cases of spinal fusion and 1,752,362 non-cases. Comparing prior spinal fusion versus no spinal fusion in primary THA, RRs (95% CI) for dislocation was 2.23 (1.81 to 2.74; seven studies), revision 2.14 (1.63 to 2.83; five studies), periprosthetic joint infection 1.71 (1.53 to 1.92; four studies), periprosthetic fracture 1.52 (1.28 to 1.81; three studies), aseptic loosening 1.76 (1.54 to 2.01; three studies), and any complications 2.82 (1.37 to 5.80; three studies) were identified. Both short and long spinal fusions, when compared with no fusion, were associated dislocation, revision, or reasons for revision. Conclusions Patients with prior spinal fusion are at risk of adverse events following primary THA. Measures that reduce the risk of these complications should be considered in this high-risk population when undergoing primary THA. These patients should also be counselled appropriately around their risks of undergoing THA. Cite this article: Bone Joint J 2020;102-B(6):664–670.
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Affiliation(s)
- Michael C. Wyatt
- Orthopaedic Department, Mid-Central District Health Board, Palmerston North, New Zealand
| | - Setor K. Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Andrew D. Beswick
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Michael R. Whitehouse
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - David C. Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury School of Medicine, University of Otago, Christchurch, New Zealand
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Surgical Treatment of Patients With Dual Hip and Spinal Degenerative Disease: Effect of Surgical Sequence of Spinal Fusion and Total Hip Arthroplasty on Postoperative Complications. Spine (Phila Pa 1976) 2020; 45:E587-E593. [PMID: 31809465 DOI: 10.1097/brs.0000000000003351] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine how lumbar spinal fusion-total hip arthroplasty (LSF-THA) operative sequence would affect THA outcomes. SUMMARY OF BACKGROUND DATA Outcomes following THA in patients with a history of lumbar spinal degenerative disease and fusion are incompletely understood. METHODS The PearlDiver Research Program (http://www.pearldiverinc.com) was used to identify patients undergoing primary THA. Patients were divided into four cohorts: 1) Primary THA without spine pathology, 2) remote LSF prior to hip pathology and THA, and patients with concurrent hip and spinal pathology that had 3) THA following LSF, and 4) THA prior to LSF. Postoperative complications and opioid use were assessed with multivariable logistic regression to determine the effect of spinal degenerative disease and operative sequence. RESULTS Between 2007 and 2017, 85,595 patients underwent primary THA, of whom 93.6% had THA without lumbar spine degenerative disease, 0.7% had a history of remote LSF, and those with concurrent hip and spine pathology, 1.6% had THA prior to LSF, and 2.4% had THA following LSF. Patients with hip and lumbar spine pathology who underwent THA prior to LSF had significantly higher rates of dislocation (aOR = 2.46, P < 0.0001), infection (aOR = 2.65, P < 0.0001), revision surgery (aOR = 1.91, P < 0.0001), and postoperative opioid use at 1 month (aOR: 1.63, P < 0.001), 3 months (aOR = 1.80, P < 0.001), 6 months (aOR: 2.69, P < 0.001), and 12 months (aOR = 3.28, P < 0.001) compared with those treated with THA following LSF. CONCLUSION Patients with degenerative hip and lumbar spine pathology who undergo THA prior to LSF have a significantly increased risk of postoperative dislocation, infection, revision surgery, and prolonged opioid use compared with THA after LSF. Surgeons should consider the surgical sequence of THA and LSF on outcomes for patients with this dual pathology. Shared decision making between patients, spine surgeons, and arthroplasty surgeons is necessary to optimize outcomes in patients with concomitant hip and spine pathology. LEVEL OF EVIDENCE 3.
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14
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Affiliation(s)
- Mengnai Li
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Andrew Glassman
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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Lu Y, Xiao H, Xue F. Causes of and treatment options for dislocation following total hip arthroplasty. Exp Ther Med 2019; 18:1715-1722. [PMID: 31410129 PMCID: PMC6676097 DOI: 10.3892/etm.2019.7733] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022] Open
Abstract
The second most common complication following total hip arthroplasty (THA) is dislocation. The majority of dislocations occur early in the post-operative period and are due to either patient-associated or surgical factors. The patient-associated factors that have been implicated as causes of post-operative dislocation include previous surgery, lumbar spine fusion surgery and/or neurological impairment. The surgical factors include surgical approach, component orientation and prosthetic and/or bony impingement. In order to delineate the cause of the hip instability a thorough history and physical and a radiographic assessment (possibly including advanced imaging) needs to be performed. Approximately two thirds of cases are successfully treated; one third of cases will require surgical treatment (e.g., revision arthroplasty (including constrained liners, the use of elevated rim liners and dual mobility implants or trochanteric advancement). In this review, we discuss the causes leading to dislocation following THA and evaluate the different treatment options available.
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Affiliation(s)
- Yian Lu
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
| | - Haijun Xiao
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
| | - Feng Xue
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
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