Does lumbar arthrodesis compromise outcome of total hip arthroplasty?

Abstract

This matched cohort study aims to determine whether the presence of a spinal arthrodesis (SA) compromises outcome of total hip arthroplasty (THA) and whether the outcome is better if THA is performed before- (THA-1^st) or after- SA (THA-2^nd). This is a single centre, multi-surgeon, review of prospective data. Thirty-seven patients (47 hips) that had SA and 1° THA(s), formed the cases (26 THA-1^st; 21 THA-2^nd). Most cases had 1-level SA (<i>n</i> = 24). Controls were patients without SA that had THA, over the same period matched for age, gender and prosthesis type. Outcome measures included complication-, revision- rates, Oxford-Hip- and Harris-Hip-Scores (OHS/HHS) (Δ: difference between pre- and post-operative scores). This is a single-centre, multi-surgeon, review of prospective data. At a mean follow-up of 6 years, more complications were seen in cases of THA and SA compared with controls without SA (7 vs. 2) (<i>p</i> = 0.03). Consequently, more cases were revised (<i>n</i> = 4) compared with controls (<i>n</i> = 0) (<i>p</i> = 0.02). There were no differences in functional outcome between cases and controls (<i>p</i> = 0.1-0.6). No differences in complications- (4/26 vs. 3/21; <i>p</i> = 1.00) or revision- rates (2/26 vs. 2/21; <i>p</i> = 1.00) were seen between THA-1^st and THA-2^nd Groups. The THA-1^st Group had higher pre- and post-operative OHS/HHS, compared to the THA-2^nd Group. However, no significant difference in ΔOHS (24 vs. 17) and ΔHHS (39 vs. 26) were seen between the THA-1^st and THA-2^nd Groups (<i>p</i> = 0.1). Patients with THA and SA, had increased rates of revision; but no differences in patient-reported outcome measures (PROMs) were detected. Addressing the hip pathology first may be associated with improved functional outcome.