Does lumbar spine fusion predispose patients to future total hip replacement?

A Comprehensive Bibliometric Analysis and Visualization of Publication Trends in Hip-Spine Syndrome

OBJECTIVE

Hip-spine syndrome (HSS) was first described in 1983 as a syndrome characterizing the concurrent symptoms of lumbar and hip joint degenerative disease. This study aims to elucidate the research trends, hot topics, and influential publications in HSS through bibliometric analysis.

METHODS

The Web of Science database was used to search for all literature on HSS from 1983 to 2024. VOSviewer, CiteSpace, and Scimago Graphica software were employed to analyze the data and generate visual knowledge maps. Analyses included annual publication trends, keywords, authors, citation bursts, co-citation situations, and research clustering hotspots.

RESULTS

Of the 236 publications meeting the inclusion criteria, the volume on HSS has steadily increased over the past 40 years. The United States leads in publication volume, followed by Australia and Japan. Total hip arthroplasty, clinical significance, and disease classification have emerged as frontiers and hotspots. The journals with the highest publication volumes are the Journal of Arthroplasty, Spine, and European Spine Journal. Key articles have been identified as foundational works in the field. However, international, institutional, and authorial collaboration remains limited.

CONCLUSIONS

Over the past 4 decades, the volume of publications on HSS has steadily increased. The United States leads both in the quality and quantity of published articles. The most influential works have enhanced our understanding of the pathogenesis and surgical decision-making in HSS. This study provides a comprehensive review of the trends and influential research in HSS.

Phase-specific changes in hip joint loading during gait following sacroiliac joint fusion: Findings from a finite element analysis

BACKGROUND

Low back pain affects over 80 % of adults, with sacroiliac joint dysfunction accounting for 15-30 % of these cases. Sacroiliac fusion is a surgical procedure for refractory joint pain. While the biomechanics of the joint and its fusion relative to the spinal column are well-known, the hip-spine relationship post-fusion remains unclear. Understanding the biomechanical state following fusion can enhance patient recovery and optimize surgical outcomes. This study uses finite element analysis to assess hip joint biomechanics following sacroiliac joint fusion.

METHODS

CTs of a 55-year-old male were used to create a biomechanical model, validated against a cadaveric study. Three triangular titanium alloy implants were placed across the sacroiliac joint in a unilateral and bilateral configuration. The model, loaded with pelvis and hip joint kinematics during a gait cycle, calculated joint reaction forces, contact stress and area on the hip joint across various gait phases.

FINDINGS

Hip joint contact stresses varied with fixation configurations and gait phases. Unilateral right fusion reduced joint reaction forces by 2 % but increased contact stress by 3.7 %. Bilateral fusion increased joint reaction forces by 6.7 % and contact stress by 3.25 %, with higher stress during foot flat and heel off phases compared to unilateral fixation.

INTERPRETATION

Fusion alters hip loading patterns during specific gait phases, with bilateral fusion producing the highest stresses during foot flat and heel off. These findings may suggest the need for fusion-specific rehabilitation protocols and warrants further investigation of long-term joint health outcomes.

Surgical Management of Hip-Spine Syndrome: A Systematic Review of the Literature

BACKGROUND

Hip-spine syndrome (HSS) was first described in 1983 to describe the symptomatology resulting from concomitant lumbar degenerative stenosis and hip osteoarthritis. Numerous studies have sought to understand the underlying pathology and appropriate management of this syndrome. The purpose of this article is to review the literature for the specific imaging characteristics and the optimal surgical treatment of HSS.

METHODS

A systematic review was conducted via an electronic database search through PubMed to identify all publications related to HSS. All publications that contained data on patients who underwent surgical treatment for HSS and reported patient-reported outcome measures or radiographic data were included. Exclusion criteria consisted of publications in a language other than English, review articles, and technique articles.

RESULTS

Fifteen articles that focused on the surgical management of HSS were identified. Of these 15 articles, 8 reported radiographic outcomes, with most reporting no significant change in spinopelvic parameters before and after surgery. Thirteen articles reported clinical outcomes, with 8 of those 13 articles identifying patient-reported outcome measures to be significantly improved following surgery.

CONCLUSIONS

The data on the surgical management of HSS remains sparse. While there is some evidence that total hip arthroplasty in patients who previously underwent spinal fusion may have higher complication rates, there remains debate regarding which surgical problem to address first, the hip or the spine.