Total hip arthroplasty increases the odds of revision in lumbar fusion: a national cohort study.

Abstract

Retrospective cohort study. To compare lumbar spine revision rates and postoperative complications among patients with concurrent hip osteoarthritis (OA) and lumbar spine pathology (LSP) who underwent lumbar fusion (LF) alone, LF before total hip arthroplasty (THA), or LF after THA. Few studies have examined how the sequence of THA and LF affects outcomes. One study found that performing THA first in patients with concurrent spine disease was associated with fewer subsequent surgeries, postoperative instability, and reduced opioid use. However, there is a lack of robust evidence on this topic. A retrospective cohort study was conducted using the PearlDiver national database to compare patients with LSP treated with LF and hip OA treated with THA, categorized by surgical sequence: THA followed by LF (THA_LF) or LF followed by THA (LF_THA). Multivariable logistic regression was used to calculate adjusted odds ratios, adjusting for age, sex, region, Elixhauser comorbidity index, insurance plan, and diabetes status. A total of 70,265 patients met the inclusion criteria. At 5-year follow-up, lumbar revision rates were 8.6% in the LF_THA cohort and 8.4% in the THA_LF cohort. Compared with patients who underwent LF alone, the adjusted odds of lumbar revision were 5.59 times higher in LF_THA (p <0.001) and 2.61 times higher in THA_LF (p <0.001). Ninety-day outcomes varied among cohorts, with the LF_THA cohort demonstrating the highest odds of complications. In this large national cohort, undergoing LF before THA was associated with increased odds of spinal revision and postoperative complications compared with undergoing THA first or LF alone.