Patients Requiring Both Total Hip Arthroplasty and Lumbar Spinal Fusion Have Lower Hip Functional Outcome Scores: A Matched Case-Control Study

Abstract

Introduction

While patients who have lumbar spinal fusion (LSF) and total hip arthroplasty (THA) have increased complication rates compared to patients who do not have LSF, there is a paucity of literature evaluating THA functional outcomes in patients having a history of LSF. This study was conducted to determine whether patients undergoing THA having a history of LSF have inferior functional outcomes compared to patients having no history of LSF.

Methods

A retrospective matched case-control study was conducted at an academic center. Patients who underwent both THA and LSF (cases) were matched with controls who underwent THA without LSF. Inclusion criteria required a minimum of one-year follow-up for the Hip Disability and Osteoarthritis Outcome Score Joint Replacement [HOOS-JR]. Following propensity matching for age, sex, race, body mass index, and comorbidities, 291 cases and 1,164 controls were included, with no demographic differences.

Results

Patients who underwent both THA and LSF had a significantly lower preoperative HOOS-JR (47 versus 50; P < 0.001), postoperative HOOS-JR (77 versus 85; P < 0.001), a significant lower rate of achieving the patient acceptable symptom state (PASS) (55 versus 67%; P < 0.001), with no significant difference in Delta HOOS-JR (34 versus 34; P = 0.834). When comparing patients undergoing THA before LSF or LSF before THA, no differences existed for preoperative HOOS-JR(50 versus 47; P = 0.304), but patients undergoing THA before LSF had lower postoperative HOOS-JR scores (74 versus 81; P = 0.034), a lower delta HOOS-JR (27 versus 35; P = 0.022), and a lower rate of reaching the HOOS-JR minimal clinically important difference (62 versus 76%; P = 0.031).

Discussion/Conclusion

Patients who have a history of LSF experience a similar improvement in hip function when undergoing THA compared to patients who do not have a history of LSF. However, due to lower preoperative function, they may have a lower postoperative functional outcome ceiling. Additionally, patients undergoing THA before LSF have worse hip functional outcomes than patients undergoing LSF before THA.