2023, Vol. 27 ›› Issue (36): 5801-5805

A matched controlled trial of lumbar fusion effect on mid-term outcomes after total hip arthroplasty

Guo Zhuotao1, Zhang Kai1, Zha Guochun2, Guo Kaijin2   

Abstract: BACKGROUND: In recent years, the number of patients with simultaneous lumbar and hip joint diseases and undergoing surgery has increased. The mid-term prognosis of patients with lumbar fusion after total hip arthroplasty is rarely studied.  
OBJECTIVE: To investigate the mid-term effect of total hip arthroplasty in patients with lumbar fusion.   
METHODS: Clinical and imaging data of patients who received initial total hip arthroplasty at the Affiliated Hospital of Xuzhou Medical University from January 2014 to January 2019 were retrospectively analyzed. Patients were divided into a fusion group and a non-fusion group according to whether there was lumbar fusion before surgery. There were 41 patients in the fusion group. Among the patients with concurrent total hip arthroplasty, gender, age, body mass index ±5, visual analog scale score ±2, preoperative Harris hip score ±10 maintained 1:2 matching, and 82 patients were selected as the non-fusion group. The complications and Harris hip score of the two groups at the last postoperative follow-up were compared, and the fusion group was divided into a pelvic stiffness group (ΔPT<20°) and a non-pelvic stiffness group (ΔPT≥20°) according to the changes of pelvic tilt angle (ΔPT) between standing and sitting positions before surgery. The difference in curative effect was compared between the two groups.
RESULTS AND CONCLUSION: (1) All patients were followed up for more than 36 months.   The rate of dislocation in the fusion group was higher than that in the non-fusion group (P=0.035).   (2) The range of motion score (P=0.030) and total Harris hip score (P=0.001) in the fusion group were lower than those in the non-fusion group. (3) The Harris hip score of the patients of pelvic stiffness group at the last follow-up was significantly lower than that of the non-pelvic stiffness group (P=0.032). (4) It is concluded that the prognosis of patients with lumbar fusion after total hip arthroplasty was worse than that of patients with general total hip arthroplasty, especially those with pelvic stiffness. Moreover, patients with lumbar fusion have a higher risk of dislocation after surgery. This provides support for routine preoperative spinal imaging in patients with prior lumbar fusion and pre-total hip arthroplasty and provides the patient with postoperative expectations.

Key words: total hip arthroplasty, lumbar fusion, pelvic stiffness, postoperative efficacy, dislocation