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Chatterjee A, Yao K, Nasra MH, Itthipanichpong T, Galano G, Ranawat AS. Patients with a history of lumbar fusion have a higher risk of revision arthroscopy and conversion to total hip arthroplasty after primary hip arthroscopy. Arthroscopy 2024:S0749-8063(24)00624-8. [PMID: 39216680 DOI: 10.1016/j.arthro.2024.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/21/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To characterize the risk of revision hip arthroscopy or conversion to total hip arthroplasty (THA) among patients with a history of lumbar fusion undergoing primary hip arthroscopy. METHODS We used the Statewide Planning and Research Cooperative System, an administrative database including all ambulatory and inpatient surgery encounters in New York (NY), to identify all patients who underwent hip arthroscopy for FAI between 2010-2020. Patients with prior lumbar fusion were identified using CPT and ICD 9th/10th Revision coding definitions. Patients with and without prior fusion were matched in a 1:5 ratio according to age and comorbidity burden. The number of levels fused was defined in the following fashion: i) no fusion, ii) 1-2 levels, or iii) ≥3 levels. Patients were followed for two years to evaluate the rate of revision hip arthroscopy or conversion to THA. Multivariable logistic regression models were used to measure the association between number of levels fused and revision hip arthroscopy or conversion to THA. RESULTS Between 2010-2020, there were 23,277 patients that underwent primary hip arthroscopy in NY state. Of these, 348 (1.4%) had a prior lumbar fusion. After matching for age and comorbidities, the composite rate of revision hip arthroscopy or conversion to THA was higher in patients with prior lumbar fusion compared to patients without (16.5% vs. 8.5%; P < 0.001). This risk increased with the number of levels fused (1-2 levels: 15.1%; aOR, 1.8; 95% CI, 1.3-2.6; vs. ≥3 levels: 26.3%; aOR, 3.4; 95% CI, 1.7-7.0). CONCLUSION Patients with a history of lumbar fusion had significantly higher rates of revision hip arthroscopy and conversion to THA compared to patients without prior fusion. The risk of revision hip arthroscopy or conversion to THA was increased approximately 2-fold in patients with 1-2 levels fused and 3-fold in patients with 3 or more levels fused. LEVEL OF EVIDENCE Level III, prognostic retrospective matched comparative case series.
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Affiliation(s)
| | - Kaisen Yao
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York City, NY
| | - Matthew H Nasra
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York City, NY
| | - Thun Itthipanichpong
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY
| | - Gregory Galano
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York City, NY. https://twitter.com/GregoryGalanoMD
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY
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Kleeman-Forsthuber L, Kurkis G, Madurawe C, Jones T, Plaskos C, Pierrepont JW, Dennis DA. Hip-spine parameters change with increasing age. Bone Joint J 2024; 106-B:792-801. [PMID: 39084653 DOI: 10.1302/0301-620x.106b8.bjj-2023-1197.r1] [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] [Indexed: 08/02/2024]
Abstract
Aims Spinopelvic pathology increases the risk for instability following total hip arthroplasty (THA), yet few studies have evaluated how pathology varies with age or sex. The aims of this study were: 1) to report differences in spinopelvic parameters with advancing age and between the sexes; and 2) to determine variation in the prevalence of THA instability risk factors with advancing age. Methods A multicentre database with preoperative imaging for 15,830 THA patients was reviewed. Spinopelvic parameter measurements were made by experienced engineers, including anterior pelvic plane tilt (APPT), spinopelvic tilt (SPT), sacral slope (SS), lumbar lordosis (LL), and pelvic incidence (PI). Lumbar flexion (LF), sagittal spinal deformity, and hip user index (HUI) were calculated using parameter measurements. Results With advancing age, patients demonstrate increased posterior APPT, decreased standing LL, decreased LF, higher pelvic incidence minus lumbar lordosis (PI-LL) mismatch, higher prevalence of abnormal spinopelvic mobility, and higher HUI percentage. With each decade, APPT progressed posteriorly 2.1°, LF declined 6.0°, PI-LL mismatch increased 2.9°, and spinopelvic mobility increased 3.8°. Significant differences were found between the sexes for APPT, SPT, SS, LL, and LF, but were not felt to be clinically relevant. Conclusion With advancing age, spinopelvic biomechanics demonstrate decreased spinal mobility and increased pelvic/hip mobility. Surgeons should consider the higher prevalence of instability risk factors in elderly patients and anticipate changes evolving in spinopelvic biomechanics for young patients.
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Affiliation(s)
| | | | | | | | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA
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Robbins SM, Tyrpenou E, Lee S, Ippersiel P, Antoniou J. Impact of combined lumbar spine fusion and total hip arthroplasty on spine, pelvis, and hip kinematics during a sit to stand task. J Electromyogr Kinesiol 2024; 75:102871. [PMID: 38460219 DOI: 10.1016/j.jelekin.2024.102871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024] Open
Abstract
Lumbar fusion is a risk factor for hip dislocation following total hip arthroplasty (THA). The objective was to compare joint/segment angles during sit-stand-sit in participants that had a THA with and without a lumbar fusion. The secondary objective was to compare pain, physical function, disability, and quality of life. This cross-sectional study includes participants that had THA and lumbar fusion (THA-fusion; n = 12) or THA only (THA-only; n = 12). Participants completed sit-stand-sit trials. Joint/segment angles were measured using electromagnetic motion capture. Angle characteristics were determined using principal component analysis. Hierarchical linear models examined relationships between angle characteristics and groups. Pain, physical function, and disability were compared using Mann-Whitney U tests. Upper lumbar spine was more extended during sit-stand-sit in the THA-fusion group (b = 42.41, P = 0.04). The pelvis was more posteriorly and anteriorly tilted during down and end sit-stand-sit phases, respectively, in the THA-fusion group (b = 12.21, P = 0.03). There were no significant associations between group and other angles. THA-fusion group had worse pain, physical function, disability, and quality of life. Although differences in spine joint, pelvis segment, and hip joint angles existed, these findings are unlikely to account for the increased incidence of hip dislocation after total hip arthroplasty in patients that had spine fusion.
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Affiliation(s)
- Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
| | - Evangelos Tyrpenou
- Division of Orthopaedic Surgery, SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Soomin Lee
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Patrick Ippersiel
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, and the School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - John Antoniou
- Division of Orthopaedic Surgery, SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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Kazarian GS, Du J, Gang CH, Shahi P, Asada T, Lu A, Korsun M, Tuma O, Singh N, Araghi K, Maayan O, Singh S, Iyer S. Preoperative and Postoperative Segmental and Overall Range of Motion in Patients Undergoing Lumbar Spinal Fusion Using HA-Infused PEEK and HA-Treated Titanium Alloy Interbody Cages. Global Spine J 2023:21925682231223117. [PMID: 38116633 DOI: 10.1177/21925682231223117] [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] [Indexed: 12/21/2023] Open
Abstract
STUDY DESIGN Retrospective observational radiographic analysis. OBJECTIVE Determine how single level lumbar interbody fusion (LIF) alters segmental range of motion (ROM) at adjacent levels and decreases overall ROM. METHODS This study included 54 patients who underwent single-level anterior (ALIF, 39%), thoraco-LIF (TLIF, 26%), posterior LIF (PLIF, 22%), or lateral LIF (LLIF, 13%) (L2-3/L3-4/L4-5/L5-S1: 4%/13%/35%/48%). Segmental ROM from L1-2 to L5-S1 and the overall lumbar ROM (L1-S1) were assessed from preoperative and postoperative flexion-extension radiographs. K-means cluster analysis was used to identify ROM subgroups. RESULTS The overall L1-S1 ROM decreased 14% (25.5 ± 20.4° to 22.0 ± 17.2°, P = .104) postoperatively. ROM at the fusion level decreased 77% (4.8 ± 5.0° to 1.1 ± 1.1°, P < .001). Caudal adjacent segment ROM decreased 12% (5.2 ± 5.7° to 4.6 ± 4.4°, P = .345) and cranially ROM increased 34% (4.3 ± 5.0° to 5.7 ± 5.7°, P = .05). K-cluster analysis identified 3 distinct clusters (P < .05). Cluster 1 lost more ROM and had less improvement in patient-reported outcomes measures (PROMs) than average. Cluster 2 had less ROM loss than average with worse PROMs improvement. Cluster 3 did not have changes in ROM and better improvement in PROMs than average. Successful fusion was verified in 96% of all instrumented segments with >6 months follow-up (ROM <4°). CONCLUSION Following single-level L IF, patients should expect a loss of 3.3°, or 14% of overall lumbar motion with increases in ROM of the cranial segment. However, specific clusters of patients exist that experience different relative changes in ROM and PROMs.
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Affiliation(s)
- Gregory S Kazarian
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Jerry Du
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | | | - Pratysuh Shahi
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Tomoyuki Asada
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Amy Lu
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Maximillian Korsun
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Olivia Tuma
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Nishtha Singh
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Kasra Araghi
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Omri Maayan
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Sumedha Singh
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Sravisht Iyer
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
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Li Y, Qian BP, Qiu Y, Yu Y, Wang B. Risk factors of hip joint structural changes following pedicle subtraction osteotomy for ankylosing spondylitis-related thoracolumbar kyphosis: a minimum two-year observation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2293-2302. [PMID: 37154940 DOI: 10.1007/s00586-023-07726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To determine the clinical- and surgical-related factors of hip joint structural changes in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who underwent PSO. METHODS Hip involvement was assessed by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) and defined by a score of at least 2. 52 patients with BASRI-h scores maintained and 78 patients with BASRI-h scores increased during follow-up were retrospectively reviewed. Clinical data were recorded. Radiological assessment was performed preoperatively, postoperatively, and at the final follow-up. RESULTS No significant difference existed in age, gender and follow-up time between the groups, but earlier onset of AS, longer disease and kyphotic duration, and worse Bath Ankylosing Spondylitis Functional Index (BASFI) scores at the final follow-up were observed in patients with BASRI-h scores increased (P < 0.05). Besides, global kyphosis (GK), T1-pelvic angle (TPA), pelvic tilt (PT) and anterior pelvic plane angle (APPA) were always larger in patients with BASRI-h scores increased, accompanied with more sacral fixation (P < 0.05). Multivariate logistics regression showed that earlier onset of AS, longer kyphotic duration, larger preoperative GK, sacral fixation and larger APPA during follow-up were independent risk factors. CONCLUSION Earlier onset of AS and longer kyphotic duration were the clinical risk factors of hip joint structural changes in AS patients following PSO, while larger preoperative GK, sacral fixation in PSO and larger APPA during follow-up were the surgical-related factors. Surgeons should inform patients with risk factors of the possibility for severe hip joint structural changes after PSO.
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Affiliation(s)
- Yao Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Bang-Ping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Yang Yu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
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High Prevalence of Spinopelvic Risk Factors in Patients With Post-Operative Hip Dislocations. J Arthroplasty 2023; 38:706-712. [PMID: 35598762 DOI: 10.1016/j.arth.2022.05.016] [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: 12/06/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Excessive standing posterior pelvic tilt (PT), lumbar spine stiffness, low pelvic incidence (PI), and severe sagittal spinal deformity (SSD) have been linked to increased dislocation rates. We aimed to determine the prevalence of these 4 parameters in a cohort of unstable total hip arthroplasty (THA) patients and compare these to a large representative control population of primary THA patients. METHODS Forty-eight patients with instability following primary THA were compared to a control cohort of 9414 THA patients. Lateral X-rays in standing and flexed-seated positions were used to assess PT and lumbar lordosis (LL). Computed tomography scans were used to measure PI and acetabular cup orientation. Thresholds for "at risk" spinopelvic parameters were standing posterior PT ≤ -15°, lumbar flexion (LLstand-LLseated) ≤ 20°, PI ≤ 41°, PI ≥ 70°, and SSD (PI-LLstand mismatch ≥ 20°). RESULTS There were significant differences in mean spinopelvic parameters between the dislocating and control cohorts (P < .001). There were no differences in mean PI (58° versus 56°, respectively, P = .29) or prevalence of high and low PI between groups. 67% of the dislocating patients had one or more significant risk factors, compared to only 11% of the control. A total of 71% of the dislocating patients had cup orientations within the traditional safe zone. CONCLUSION Excessive standing posterior PT, low lumbar flexion, and a severe SSD are more prevalent in unstable THAs. Pre-op screening for these parameters combined with appropriate planning and implant selection may help identify at risk patients and reduce the prevalence of dislocation.
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7
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Yang DS, McDonald CL, DiSilvestro KJ, Patel SA, Li NY, Cohen EM, Daniels AH. Risk of Dislocation and Revision Following Primary Total Hip Arthroplasty in Patients With Prior Lumbar Fusion With Spinopelvic Fixation. J Arthroplasty 2023; 38:700-705.e1. [PMID: 35337945 DOI: 10.1016/j.arth.2022.03.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The effect of spinopelvic fixation in addition to lumbar spinal fusion (LSF) on dislocation/instability and revision in patients undergoing primary total hip arthroplasty (THA) has not been reported previously. METHODS The PearlDiver Research Program was used to identify patients aged 30 and above undergoing primary THA who received (1) THA only, (2) THA with prior single-level LSF, (3) THA with prior 2-5 level LSF, or (4) THA with prior LSF with spinopelvic fixation. The incidence of THA revision and dislocation/instability was compared through logistic regression and Chi-squared analysis. All regressions were controlled for age, gender, and Elixhauser Comorbidity Index (ECI). RESULTS Between 2010 and 2018, 465,558 patients without history of LSF undergoing THA were examined and compared to 180 THA patients with prior spinopelvic fixation, 5,299 with prior single-level LSF, and 1,465 with prior 2-5 level LSF. At 2 years, 7.8% of THA patients with prior spinopelvic fixation, 4.7% of THA patients with prior 2-5 level LSF, 4.2% of THA patients with prior single-level LSF, and 2.2% of THA patients undergoing only THA had a dislocation event or instability (P < .0001). After controlling for length of fusion, pelvic fixation itself was associated with higher independent risk of revision (at 2 years: 2-5 level LSF + spinopelvic fixation: aHR = 3.15, 95% CI 1.77-5.61, P < .0001 vs 2-5 level LSF with no spinopelvic fixation: aOR = 1.39, 95% CI 1.10-1.76, P < .0001). CONCLUSION At 2 years, spinopelvic fixation in THA patients were associated with a greater than 3.5-fold increase in hip dislocation risk compared to those without LSF, and an over 2-fold increase in THA revision risk compared to those with LSF without spinopelvic fixation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel S Yang
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher L McDonald
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kevin J DiSilvestro
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Shyam A Patel
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Neill Y Li
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eric M Cohen
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
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Ramamurti P, Quinlan ND, Deasey MJ, Kamalapathy PN, Werner BC, Browne JA. Increased Dislocation Rates After Total Hip Arthroplasty in Patients With Prior Isolated Sacroiliac Joint Arthrodesis. J Arthroplasty 2023:S0883-5403(23)00279-6. [PMID: 36966890 DOI: 10.1016/j.arth.2023.03.051] [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: 11/25/2022] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND While stiffness of the lumbosacral spine is a known predictor of instability following total hip arthroplasty (THA), little is known about the medical- and surgical-related outcomes following THA in patients who have prior isolated sacroiliac (SI) joint arthrodesis. METHODS 197 patients who had a history of isolated SI joint arthrodesis who subsequently underwent elective primary THA for a diagnosis of osteoarthritis (THA-SI) from 2015 to 2021 were identified in a national administrative database. Using propensity score matching and logistic regression analyses, this cohort was compared to two groups of patients: patients who did not have any history of lumbar or SI arthrodesis and patients undergoing primary THA who had a history of lumbar arthrodesis without extension into the SI joint (THA-LF). RESULTS The THA-SI group had a significantly higher incidence of dislocation (odds ratio 2.06, 95% confidence interval 1.04-4.04, P = .037) with no increased incidence of medical complications or other surgical complications when compared to patients without a history of SI or lumbar arthrodesis. There were no significant differences in any complications in THA-SI patients when compared to THA-LF patients. CONCLUSION Patients who had prior isolated SI joint arthrodesis undergoing primary THA demonstrated a two-fold increased incidence of dislocation when compared to those who did not have prior SI arthrodesis, although the risk of complications in this population was similar to that observed in patients who had prior isolated lumbar spine arthrodesis.
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Affiliation(s)
- Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicole D Quinlan
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Matthew J Deasey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Pramod N Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Complications following total hip arthroplasty and hemiarthroplasty for femoral neck fractures in patients with a history of lumbar spinal fusion. Arch Orthop Trauma Surg 2023; 143:817-827. [PMID: 34595546 DOI: 10.1007/s00402-021-04158-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this study was to examine whether previous lumbar spinal fusion (LSF) was an independent risk factor for complications in patients undergoing total hip arthroplasty (THA) or hemiarthroplasty for displaced femoral neck fractures. METHODS AND MATERIALS An administrative database was queried from 2010 to Q2 of 2019 to analyze and compare complications in patients undergoing either THA or hemiarthroplasty for femoral neck fracture with a history of LSF versus no history of LSF. Joint complications including periprosthetic fracture, prosthetic joint infection (PJI), prosthetic joint dislocation (PJD), aseptic loosening, and prosthetic revision were examined at 90 days and 1 year post-operatively. RESULTS In the THA cohort, patients with prior LSF had significantly higher likelihood of aseptic loosening at 90 days and 1 year post-operatively in comparison to those without prior LSF (90-day: OR 2.22; 1-year: OR 1.95). Patients in the hemiarthroplasty cohort with prior LSF had significantly higher likelihood of PJI (90-day: OR 2.18; 1-year: OR 2.37), aseptic loosening (90-day: OR 3.42; 1-year: OR 4.68), and prosthetic revision (90-day: OR 2.27; 1-year: OR 2.25) in both the 90-day and 1-year postoperative period in comparison to those without prior LSF. Additionally, for the same cohort, periprosthetic fracture (1-year: OR 2.32) and PJD (1-year: OR 2.31) were significantly higher at 1-year postoperative. CONCLUSION Presence of LSF was found to be an independent risk factor for increased joint complications in patients undergoing either a THA or hemiarthroplasty for displaced femoral neck fractures.
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Fourman MS, Yates AJ, Kim HJ. Clinical Faceoff: Hip Osteoarthritis in the Setting of Adult Spinal Deformity. Clin Orthop Relat Res 2023; 481:32-38. [PMID: 36410010 PMCID: PMC9750692 DOI: 10.1097/corr.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Mitchell S. Fourman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Adolph J. Yates
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Does fusion length matter? Total hip arthroplasty dislocation after extension of lumbosacral fusion: a case report. Spine Deform 2023; 11:253-257. [PMID: 35921039 DOI: 10.1007/s43390-022-00563-z] [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: 06/09/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
CASE Hip-spine syndrome is a complex challenge for orthopedic surgeons. We present a 60-year-old female with a history of spinal fusion and total hip arthroplasty. The patient underwent extension of the previous fusion with sacropelvic fixation, and 5 months later she presented with left posterior prosthetic hip dislocation which required sedation and closed reduction. CONCLUSION Even with no change in lumbar lordosis or pelvic tilt and adequate acetabular cup position, extension of the fusion construct may predispose patients to dislocation. This may be the result of an increased lever arm acting at the hip joint, thereby leading to instability.
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How does corrective fusion surgery for adult spinal deformities affect pelvic inclination in the supine position as the reference plane for THA? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:143-150. [PMID: 34825988 DOI: 10.1007/s00590-021-03166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the changes in pelvic inclination in the supine and standing positions after spinal corrective surgery, and to identify the most predictive factor for changes in pelvic inclination with the supine position as the reference plane for total hip arthroplasty. METHODS We retrospectively analysed the data of 124 patients who underwent spinal corrective fusion surgery for adult spinal deformity between 2012 and 2016 at our institution. Spinal parameters were assessed preoperatively and postoperatively using whole spine radiographs in the standing position. The sacral slope (SS) was measured using spine and pelvis computed tomography. Differences between the preoperative and postoperative SS values in each position were calculated as Δsupine SSpre post and Δstanding SSpre post, respectively. We statistically analysed the correlations between Δsupine SS pre post and preoperative spinal parameters to determine the most useful predictor of Δ supine SSpre post. RESULTS The mean Δsupine SSpre post of 10.5°(-13°-50°) was significantly smaller than the mean Δstanding SSpre post of 13.2° (-19°-44°) (p = 0.02). Moreover, 21 patients (17%) had Δsupine SSpre post > 20°. The Δsupine SS pre post was correlated with preoperative LL (r = -0.34 p < 0.01), PT (r = 0.42 p < 0.01), and SVA (r = 0.37 p < 0.01). Preoperative supine SS (r = -0.54, p < 0.01) had the highest correlation with Δsupine SSpre post, whereas preoperative standing SS showed no correlation (r = -0.14 p = 0.12). CONCLUSION Preoperative supine SS is the most useful predictive factor for changes in supine pelvic inclination, and low preoperative values should be noted. This information should be considered for the management of patients with hip-spine syndrome.
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Dimitriou D, Zindel C, Weber S, Kaiser D, Betz M, Farshad M. Lumbar spinal fusion does not increase early dislocation risk in primary total hip arthroplasty through the direct anterior approach. Arch Orthop Trauma Surg 2022; 142:3469-3475. [PMID: 34643783 DOI: 10.1007/s00402-021-04203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with total hip arthroplasty (THA) and a concomitant lumbar spinal fusion (LSF) might have an increased incidence of revision surgery and postoperative complications such as early THA dislocation. The direct anterior approach (DAA) has gained popularity in THA due to its soft tissue-preserving nature and the relatively low dislocation risk. The purpose of the present study was to examine whether LSF patients undergoing minimally invasive THA through the DAA might have an increased risk of prosthetic-related complications compared to matched-control patients without a LSF. MATERIALS AND METHODS Patients who underwent THA through the DAA in our institution from January 2014 to December 2018 were identified. A total of 30 primary THA also underwent LSF within 3 months from the initial operation. These patients were randomly matched (1:3) for sex, age, and body mass index with patients who underwent primary THA in our institution without a history of LSF (control group). Peri and postoperative complications, revisions, radiographic and clinical outcomes were assessed retrospectively. RESULTS LSF patients who underwent THA through the DAA did not have an increased risk of prosthetic-related complications compared to matched-control subjects without a LSF (6.6% versus 4.4%, P < 0.05). The functional and radiological outcomes were similar between groups. CONCLUSION LSF patients undergoing THA could benefit from the DAA similarly to patients without LSF and without increased rate of early THA dislocation. Although the complex interplay between the lumbar spine and hip in THA patients warrants further investigation, the outcomes of THA through the DAA in LSF patients appear promising. LEVEL OF EVIDENCE Retrospective case-control study, III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sabrina Weber
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Dominik Kaiser
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Michael Betz
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
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Dimitriou D, Haupt S, Weber S, Winkler E, Betz M, Farshad M. The effect of lumbar spinal fusion on native acetabular anteinclination in standing position. Arch Orthop Trauma Surg 2022; 143:2733-2738. [PMID: 35767041 DOI: 10.1007/s00402-022-04531-0] [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: 01/20/2022] [Accepted: 06/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The complex and dynamic spinopelvic interplay is not well understood. The aims of the present study were to investigate the following: (1) whether native acetabular anteinclination (AI) in standing position changes following lumbar spinal fusion (LSF); (2) potential correlations between AI change (ΔAI) and several spinopelvic parameters such as the change in lumbar lordosis (ΔLL), pelvic tilt (ΔPT), and anterior pelvic plane angle (ΔaPP). METHODS A total of 485 patients (Males: 262, Females: 223) with an average age of 64 ± 13 years who underwent a primary LSF were identified from our institutional database. The difference (Δ) between pre-and postoperative acetabular anteinclination (AI), lumbar lordosis (LL), anterior pelvic plane angle (aPP), sacral slope (SS), and pelvic tilt (PT) were measured on a standing lateral radiograph (EOS®) and compared to find the effect of LSF on the lumbopelvic geometry. RESULTS Following LSF, the average absolute ΔAI was 5.4 ± 4 (0 to 26)°, ΔLL: 5.5 ± 4 (0 to 27)°, ΔaPP: 5.4 ± 4 (0 to 38)°, ΔPT: 7 ± 5 (0 to 33)° and ΔSS: 5.3 ± 4 (0 to 33)°. No significant differences were observed between LSF levels. A ΔAI ≥ 10° was observed in 66 (13.6%) and ΔAI ≥ 20° in 5 (1%) patients. The Pearson correlation demonstrated a strong negative correlation of ΔAI with ΔLL (r = 0.72, p < .001). CONCLUSION Clinical decision-making should consider the relationship between native anteinclination and lumbar lordosis to reduce the risk of functional acetabular component malalignment in patients with concomitant hip and spine pathology. LEVEL OF EVIDENCE Retrospective case-control study, Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Samuel Haupt
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sabrina Weber
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Elin Winkler
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Michael Betz
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
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Arand C, Noser H, Kamer L, Gehweiler D, Handrich K, Rommens PM, Wagner D. Is there a correlation between pelvic incidence and orientation of the acetabulum? An analysis based on a three-dimensional statistical model of the pelvic ring. J Anat 2022; 241:756-764. [PMID: 35662008 PMCID: PMC9358766 DOI: 10.1111/joa.13708] [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: 12/09/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 12/29/2022] Open
Abstract
The pelvic ring is a complex anatomical structure building up the connection between the trunk and the legs. Whilst there is a broad discussion in the literature about the dynamic interaction between spine, pelvis and the hip joints, there is still little information about the relation and interaction of the constant pelvic parameters. Based on a three‐dimensional (3D) statistical model consisting of 150 uninjured and bony healthy pelves (100 Europeans, 50 Japanese; 81 males, 69 females; average age 74.3 years ± 17.5 years) an evaluation of pelvic incidence (PI) and acetabular orientation in anteversion and inclination was performed and potential correlations of these intraindividual constant parameters were investigated. Pelvic incidence is defined as the angle between the perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle axis of the femoral heads. Acetabular anteversion is defined as the angle between the perpendicular to the best‐fit plane on the acetabular rim and the coronal plane measured in strict lateral view. Acetabular inclination is defined as the angle between the perpendicular to the best‐fit plane on the acetabular rim and the sagittal plane in strict frontal view. Data were further analysed with regard to different subgroup's age, sex and ethnicity. A positive correlation between PI and acetabular anteversion could be demonstrated. Further, PI and also the acetabular parameters anteversion and inclination were found to be significantly higher in the European individuals than in the Asian. The results of the present study demonstrate a relation between the anatomical configuration of the constant pelvic parameters building up the connection points to the next proximal respectively caudal skeleton section. The findings might lead to more comprehensive treatment strategies in case of trauma or degenerative pathologies of the pelvis in the future.
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Affiliation(s)
- Charlotte Arand
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | | | - Lukas Kamer
- AO Research Institute Davos, Davos, Switzerland
| | | | - Kirstin Handrich
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
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Li Y, Qian BP, Qiu Y, Zhao SZ, Zhong XL, Wang B. Influence of lumbar sagittal profile on pelvic orientation and pelvic motion during postural changes in patients with ankylosing spondylitis-related thoracolumbar kyphosis following pedicle subtraction osteotomy. J Neurosurg Spine 2022; 36:624-631. [PMID: 34715648 DOI: 10.3171/2021.7.spine21114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the impact of the lumbar sagittal profile on pelvic orientation and pelvic motion during postural changes in patients with ankylosing spondylitis (AS) and thoracolumbar kyphosis and to evaluate the potential risk of prosthetic dislocation after total hip arthroplasty (THA) following pedicle subtraction osteotomy (PSO). METHODS Seventy-two patients with AS-related thoracolumbar kyphosis following spinal osteotomy were retrospectively reviewed, and 21 healthy volunteers were recruited as a control group. Pre- and postoperative 2D full-body images in standing and sitting positions were obtained to evaluate the anterior pelvic plane angle (APPA), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), proximal femur angle (PFA), and femoroacetabular flexion during postural changes. Patients with AS were categorized in either a lordotic or kyphotic group based on the lumbar sagittal profile. RESULTS Significant increases in the SS and decreases in the APPA, PT, and LL were observed postoperatively in both the standing and sitting positions (p < 0.001 for all). Significantly higher APPA, PT, LL, and ΔPT, and lower SS, ΔSS, and ΔSS+ΔPFA were observed in the kyphotic group (p < 0.05). After undergoing PSO, ΔPT and ΔSS significantly decreased while femoroacetabular flexion significantly increased in both AS groups (p < 0.05), and no significant difference was present between the two groups (p > 0.05). Bath Ankylosing Spondylitis Radiology Hip Index scores in the kyphotic group were significantly worse than those in the lordotic group pre- and postoperatively (p < 0.05). No significant difference in parameters concerning pelvic motion (ΔAPPA, ΔPT, and ΔSS) was found when PSO was performed in the thoracolumbar or lumbar spine. CONCLUSIONS Lumbar sagittal profiles greatly affect pelvic orientation and pelvic motion in AS. When THA is performed before PSO, AS patients with lumbar kyphosis are at higher risk of anterior prosthetic dislocation, while those with lordotic lumbar sagittal profiles are at higher risk of posterior dislocation. PSO should be performed prior to THA. After PSO, further decreased pelvic motion indicated a potential risk of posterior prosthetic dislocation after sequential THA, whereas theoretically patients with preoperative lumbar kyphosis are at higher risk of THA dislocation. The site where PSO was performed (thoracolumbar or lumbar spine) does not influence the risk of THA dislocation.
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Affiliation(s)
- Yao Li
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Qiu
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shi-Zhou Zhao
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiao-Lin Zhong
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bin Wang
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Abstract
➤ The proper diagnosis and treatment of patients with concurrent hip and spine pathological processes can be challenging because of the substantial overlap in symptomatology. ➤ There is no consensus on which pathological condition should be addressed first. ➤ Factors such as advanced spinal degeneration, deformity, and prior fusion alter the biomechanics of the spinopelvic unit. Attention should be paid to recognizing these issues during the work-up for a total hip arthroplasty as they can result in an increased risk of dislocation. ➤ In patients with concurrent spine and hip degeneration, the surgeon must pay close attention to appropriate implant positioning and have consideration for implants with enhanced stability to minimize the risk of dislocation. ➤ A proper understanding of sagittal balance and restoration of this balance is integral to improving patient outcomes following spinal surgery. ➤ The advent of new imaging modalities, increased awareness of spinopelvic mobility, as well as a better understanding of sagittal alignment will hopefully improve our treatment of patients with hip-spine syndrome.
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Affiliation(s)
| | - Diana G Douleh
- Department of Orthopedics, University of Colorado, Aurora, Colorado
| | - Philip J York
- Panorama Orthopedics and Spine, Centennial, Colorado
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Spinopelvic Biomechanics and Total Hip Arthroplasty: A Primer for Clinical Practice. J Am Acad Orthop Surg 2021; 29:e888-e903. [PMID: 34077399 DOI: 10.5435/jaaos-d-20-00953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
Abnormal spinopelvic motion from spine pathology is associated with inferior outcomes after total hip arthroplasty, including inferior patient-reported outcomes, increased rates of instability, and higher revision rates. Identifying these high-risk patients preoperatively is important to conduct the appropriate workup and formulate a surgical plan. Standing and sitting lateral spinopelvic radiographs are able to identify and quantify abnormal spinopelvic motion. Depending on the type of spinopelvic deformity, some patients may require increased anteversion, increased offset, and large diameter heads or dual mobility articulations to prevent dislocation. This review article will provide the reader with practical information that can be applied to patients regarding the terminology, pathophysiology, evaluation, and management of total hip arthroplasty patients with spinopelvic pathology.
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Concomitant Lumbar Spinal Stenosis Negatively Affects Outcomes After Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy 2021; 37:2102-2109. [PMID: 33581300 DOI: 10.1016/j.arthro.2021.01.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the prognostic effect of lumbar spinal stenosis on clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAI). METHODS Patients undergoing hip arthroscopy between September 2009 and December 2015 for FAI with concomitant lumbar spinal stenosis (central/neuroforaminal) and a 2-year follow-up were identified (hip-spine). A 1:1 case-matching query using preoperative modified Harris Hip Score (mHHS) within 3 points, body mass index (BMI) within 3 points, age within 5 years, and sex identified a control cohort without spinal pathology. Follow-up patient-reported outcomes (PROs) and clinical failure rates to revision procedure were compared using analysis of variance (ANOVA) and Kaplan-Meier survival analysis. RESULTS Twenty-six patients met criteria of the hip-spine group (age: 45.9 ± 12.2 years; BMI: 27.3 ± 5.0 kg/m2, baseline mHHS: 44.17 ± 2.76) vs the control group (age: 46.2 ± 12.4 years, P = .94; BMI: 26.7 ± 4.1 kg/m2, P = .61; baseline mHHS: 44.27 ± 2.82, P = .98). ANOVA analysis demonstrated that all PROs improved from baseline to 2-year outcomes (P < .001). The hip-spine vs control group had lower 1-year (mHHS: 65.97 ± 5.64 vs 85.04 ± 3.09, P = .006; nonarthritic hip score (NAHS): 70.26 ± 5.71 vs 87.89 ± 2.65, P = .010) and 2-year (mHHS: 69.72 ± 4.92 vs 84.71 ± 2.56, P = .007; NAHS: 72.23 ± 5.18 vs 87.14 ± 2.23, P = .008) outcomes. While there was no difference in patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) rates at 1-year follow-up, the hip-spine group demonstrated lower PASS (42% vs 81%, P = .004) and MCID (58% vs 88%, P = .027) rates at 2 years. Although susceptible to type II error, there was no difference in clinical failure rates to revision procedure (P = .13). CONCLUSIONS While net PROs from baseline improve after hip arthroscopy for FAI, the presence of concomitant lumbar spinal stenosis negatively affects postoperative PROs. FAI patients with spinal stenosis should be counseled accordingly. LEVEL OF EVIDENCE Level III, case-control study.
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20
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Kawai T, Shimizu T, Goto K, Kuroda Y, Okuzu Y, Fujibayashi S, Matsuda S. Number of Levels of Spinal Fusion Associated with the Rate of Joint-Space Narrowing in the Hip. J Bone Joint Surg Am 2021; 103:953-960. [PMID: 33770019 DOI: 10.2106/jbjs.20.01578] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fusion of a joint reportedly increases force in the adjacent joints and leads to progression of arthritis. Whether lumbar spinal fusion increases force in the hip joint and promotes wear of the joint space is unclear. The purpose of this study was to evaluate the rate of joint-space narrowing in the hip following spinal fusion and to examine the effects of the number of levels fused on the joint-narrowing rate. METHODS We retrospectively reviewed data for patients who underwent lumbar spinal fusion from 2011 to 2018 at our institute. Patients with a previous hip surgery, Kellgren-Lawrence grade ≥II hip osteoarthritis, hip dysplasia, and rheumatoid arthritis were excluded. The rate of joint-space narrowing in the hip was measured in 205 eligible patients (410 hips) following spinal fusion, and the effects of sex, age, body mass index, indication for spinal fusion, laterality, sacral fixation, and number of levels fused on the narrowing rate were examined. RESULTS The rate of joint-space narrowing for all patients was 0.114 ± 0.168 mm/year. The narrowing rate for single-level fusion was 0.062 ± 0.087 mm/year, whereas that for fusion of ≥7 levels was 0.307 ± 0.254 mm/year. In the multivariate regression analysis, only the length of fusion (standardized coefficient [SC] = 0.374, p < 0.0001) was associated with an increased narrowing rate. When the narrowing rate was normalized by height, female sex was another risk factor for increased narrowing (SC = 0.109, p = 0.023). Secondary regression modeling performed with patients who underwent spinal fusion for degenerative disc disease showed that the length of fusion (SC = 0.454, p < 0.0001) and female sex (SC = 0.138, p = 0.033) were associated with increased joint-space narrowing. CONCLUSIONS Longer spinal fusion was associated with the progression of hip joint narrowing following spinal fusion. Surgeons should be aware of the possible increased risk of hip degeneration following spinal fusion and should inform patients of this risk. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Toshiyuki Kawai
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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21
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Mononen H, Sund R, Halme J, Kröger H, Sirola J. Following total hip arthroplasty: femoral head component diameter of 32 mm or larger is associated with lower risk of dislocation in patients with a prior lumbar fusion. Bone Joint J 2020; 102-B:1003-1009. [DOI: 10.1302/0301-620x.102b8.bjj-2019-1037.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 evidence that prior lumbar fusion increases the risk of dislocation and revision after total hip arthroplasty (THA). The relationship between prior lumbar fusion and the effect of femoral head diameter on THA dislocation has not been investigated. We examined the relationship between prior lumbar fusion or discectomy and the risk of dislocation or revision after THA. We also examined the effect of femoral head component diameter on the risk of dislocation or revision. Methods Data used in this study were compiled from several Finnish national health registers, including the Finnish Arthroplasty Register (FAR) which was the primary source for prosthesis-related data. Other registers used in this study included the Finnish Health Care Register (HILMO), the Social Insurance Institutions (SII) registers, and Statistics Finland. The study was conducted as a prospective retrospective cohort study. Cox proportional hazards regression and Kaplan-Meier survival analysis were used for analysis. Results Prior lumbar fusion surgery was associated with increased risk of prosthetic dislocation (hazard ratio (HR) = 2.393, p < 0.001) and revision (HR = 1.528, p < 0.001). Head components larger than 28 mm were associated with lower dislocation rates compared to the 28 mm head (32 mm: HR = 0.712, p < 0.001; 36 mm: HR = 0.700, p < 0.001; 38 mm: HR = 0.808, p < 0.140; and 40 mm: HR = 0.421, p < 0.001). Heads of 38 mm (HR = 1.288, p < 0.001) and 40 mm (HR = 1.367, p < 0.001) had increased risk of revision compared to the 28 mm head. Conclusion Lumbar fusion surgery was associated with higher rate of hip prosthesis dislocation and higher risk of revision surgery. Femoral head component of 32 mm (or larger) associates with lower risk of dislocation in patients with previous lumbar fusion. Cite this article: Bone Joint J 2020;102-B(8):1003–1009.
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Affiliation(s)
- Henri Mononen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Health and Social Economics Unit, Department of Health and Social Care Systems, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jarkko Halme
- Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio, Finland
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