James Randolph Onggo1, Mithun Nambiar2,3, Jason Derry Onggo2,4, Kevin Phan5, Anuruban Ambikaipalan2, Sina Babazadeh2,6, Raphael Hau2,7. 1. Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia. jamesonggo1993@hotmail.com. 2. Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia. 3. Department of Surgery, The University of Melbourne, Parkville, VIC, Australia. 4. School of Medicine, Flinders University, Adelaide, SA, Australia. 5. NeuroSpine Research Group, Sydney, NSW, Australia. 6. Department of Orthopaedic Surgery, St Vincent's Hospital, East Melbourne, VIC, Australia. 7. Epworth Eastern Hospital, Box Hill, VIC, Australia.
Abstract
BACKGROUND: Hip and spine pathology can alter the biomechanics of spino-pelvic mobility. Lumbar spine fusions can reduce the mobility of the lumbar spine and therefore result in compensatory femoral motion, contributing towards dislocations of THA. PURPOSE: This meta-analysis aims to determine the effect of pre-existing spine fusions on THA outcomes, and complication profile including hip dislocations, all-cause revisions and all complications. METHODS: A multi-database search was performed according to PRISMA guidelines. All studies that compared patients who underwent THA with and without prior SF were included in the analysis. RESULTS: Ten studies were included in this review, consisting of 28,396 SF THA patients and 1,550,291 non-SF THA patients. There were statistically significant higher rates of hip dislocation (OR 2.20, 95% CI 1.71-2.85, p < 0.001), all-cause revision (OR 3.43, 95% CI 1.96-6.00, p < 0.001) and all complications (OR 2.83, 95% CI 1.28-6.24, p = 0.01) in SF than in non-SF THA patients. When registry data were excluded, these rates were approximately doubled. Subgroup analysis of revisions for dislocations was not statistically significant (OR 5.28, 95% CI 0.76-36.87, p = 0.09). While no meta-analysis was performed on clinical outcomes due to heterogeneous parameter reporting, individual studies reported significantly poorer outcomes in SF patients than in non-SF patients. CONCLUSION: THA patients with SF are at higher risks of hip dislocations, all-cause revisions and all complications, which may adversely affect patient-reported outcomes. Surgeons should be aware of these risks and appropriately plan to account for altered spino-pelvic biomechanics, in order to reduce the risks of hip dislocations and other complications. LEVEL OF EVIDENCE: II (Meta-analysis of non-homogeneous studies). These slides can be retrieved under Electronic Supplementary Material.
BACKGROUND: Hip and spine pathology can alter the biomechanics of spino-pelvic mobility. Lumbar spine fusions can reduce the mobility of the lumbar spine and therefore result in compensatory femoral motion, contributing towards dislocations of THA. PURPOSE: This meta-analysis aims to determine the effect of pre-existing spine fusions on THA outcomes, and complication profile including hip dislocations, all-cause revisions and all complications. METHODS: A multi-database search was performed according to PRISMA guidelines. All studies that compared patients who underwent THA with and without prior SF were included in the analysis. RESULTS: Ten studies were included in this review, consisting of 28,396 SF THA patients and 1,550,291 non-SF THA patients. There were statistically significant higher rates of hip dislocation (OR 2.20, 95% CI 1.71-2.85, p < 0.001), all-cause revision (OR 3.43, 95% CI 1.96-6.00, p < 0.001) and all complications (OR 2.83, 95% CI 1.28-6.24, p = 0.01) in SF than in non-SF THA patients. When registry data were excluded, these rates were approximately doubled. Subgroup analysis of revisions for dislocations was not statistically significant (OR 5.28, 95% CI 0.76-36.87, p = 0.09). While no meta-analysis was performed on clinical outcomes due to heterogeneous parameter reporting, individual studies reported significantly poorer outcomes in SF patients than in non-SF patients. CONCLUSION: THA patients with SF are at higher risks of hip dislocations, all-cause revisions and all complications, which may adversely affect patient-reported outcomes. Surgeons should be aware of these risks and appropriately plan to account for altered spino-pelvic biomechanics, in order to reduce the risks of hip dislocations and other complications. LEVEL OF EVIDENCE: II (Meta-analysis of non-homogeneous studies). These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Complications; Hip dislocation; Spinal fusion; Total hip arthroplasty; Total hip replacement
Authors: Hiroyuki Ike; Lawrence D Dorr; Nicholas Trasolini; Michael Stefl; Braden McKnight; Nathanael Heckmann Journal: J Bone Joint Surg Am Date: 2018-09-19 Impact factor: 5.284
Authors: Arthur L Malkani; Andrew T Garber; Kevin L Ong; John R Dimar; Doruk Baykal; Steven D Glassman; Adam R Cochran; Daniel J Berry Journal: J Arthroplasty Date: 2017-10-31 Impact factor: 4.757
Authors: Lane Koenig; Qian Zhang; Matthew S Austin; Berna Demiralp; Thomas K Fehring; Chaoling Feng; Richard C Mather; Jennifer T Nguyen; Asha Saavoss; Bryan D Springer; Adolph J Yates Journal: Clin Orthop Relat Res Date: 2016-10-03 Impact factor: 4.176
Authors: Keisuke Uemura; Penny R Atkins; Masashi Okamoto; Kunihiko Tokunaga; Andrew E Anderson Journal: J Orthop Res Date: 2020-04-30 Impact factor: 3.494