Patients Who Undergo Primary Lumbar Spine Fusion After Recent but Not Remote Total Hip Arthroplasty Are at Increased Risk for Complications, Revision Surgery, and Prolonged Opioid Use

Objective

To evaluate the effect of a recent history of total hip arthroplasty (THA) on primary lumbar spine fusion (LSF) for concurrent hip and spine disease.

Methods

A total of 98,242 patient records from the PearlDiver Database were evaluated and divided into 3 cohorts: 1) patients with a history of LSF alone, 2) patients with a history of LSF for newly diagnosed lumbar disease after having a remote THA> 2 years previously, and 3) patients with a history of LSF after having recent THA <2 years before LSF who initially presented with concurrent hip and lumbar spine disease and underwent THA before LSF. Postoperative outcomes were assessed with multivariable logistic regression to determine the effect of THA on outcomes after LSF with respect to postoperative complications, LSF revision rates, and opioid use.

Results

Patients who had LSF after a recent THA had increased risk of deep venous thrombosis (adjusted odds ratio [aOR], 1.39; P = 0.0191), neurologic complications (aOR, 1.81; P = 0.0459), prolonged opioid use (aOR, 1.22; P = 0.0032), and revision LSF (12.8%; P = 0.0004 vs. 9.9%; OR, 1.41; P < 0.0001; hazard ratio, 1.69; P < 0.0001).

Patients who underwent LSF after a remote history of THA had no significant difference in DVT (4.2% vs. 2.6%, aOR, 1.31; P = 0.2190), neurologic complications (1.0% vs. 0.5%, aOR, 2.02; P = 0.1220), revision surgery (9.6% vs. 9.9%, aOR, 1.06; P = 0.7197), or prolonged opioid use (36.5% vs. 24.4%, aOR, 1.17; P = 0.1120).

Conclusions

Patients who undergo LSF with a history of THA may be at increased risk of postoperative complications, revision LSF, and prolonged opioid use if their THA was performed for concurrent hip-spine disease in the recent past (<2 years).

Introduction

Degenerative diseases in the spine and hip are prevalent.¹ When occurring concomitantly, the conditions are described as hip-spine syndrome^1,2 and can present a diagnostic and surgical dilemma to clinicians. Radiographic and symptomatic disease in both regions of the body is common and physicians must use a combination of history, physical examination, and radiographic findings to elucidate the predominant pain generator. However, not infrequently, surgical treatments in the form of lumbar spine fusion (LSF) and total hip arthroplasty (THA) are necessary.³

Several recent studies have noted complications postoperatively such as dislocation, infection, and persistent pain for those who have concomitant hip and spine disease and undergo surgical intervention.4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Most studies focus on outcomes of THA in patients with previous LSF.^9,13, 14, 15 The outcomes of LSF in those with a previous history of THA remain unclear. In addition, little is known regarding how a history of THA affects opioid use after LSF.

The purpose of this study was to compare the rate of postoperative complications, rate of revision LSF, and opioid use in patients undergoing LSF who 1) undergo LSF without any history of THA, 2) undergo LSF for newly diagnosed lumbar disease with a remote (>2 year) history of THA, and 3) undergo LSF after a more recent THA (<2 years) when presenting with concurrent hip and spine disease (hip was operated on first). We hypothesize that this last cohort of patients with concurrent hip and spine diseases who undergo LSF after a more recent THA endure greater postoperative adverse events than do those patients who have a remote or no history of THA.