Not so good news for patients who have a history of lumbar spinal fusion.
New research indicates that these folks are at a higher risk of experiencing a total hip arthroplasty (THA) dislocation than individuals who have not undergone lumbar spinal fusion.
The study, “Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion,” was published April 28, 2017 in The Bone & Joint Journal.
Aaron J. Buckland, M.D. is a spinal and scoliosis surgeon and director of Spine Research at the New York University Hospital for Joint Diseases. He told OTW, “I had anecdotally noticed some late dislocations of total hip replacements in [a] patient that underwent lumbar fusion despite well positioned implants and a lack of wear. We then started looking at the effect of sitting and standing pelvic mechanics and noted that the pelvis does not retrovert to the same degree in sitting in those patients whom have had lumbar fusions. This theoretically would increase the risk of implant impingement and posterior dislocation. We therefore set out to investigate whether the presence of lumbar spinal fusion did in fact increase the risk of prosthetic dislocation in THA.”
“This paper utilized the United States Medicare and Medicaid services data over an eight-year period to look at the presence of dislocation at one year-post-total hip arthroplasty (THA). We stratified patients by the presence or absence of lumbar spinal fusion prior to THA, and for those patients who had a lumbar spinal fusion, we sub-stratified them by 1-2 level fusion versus 3-7 level fusion based on procedural billing codes.”
“Patients with a prior lumbar fusion had a higher dislocation rate after THA when compared to patients without a lumbar fusion. Patients with a 3-7 level spinal fusion had a higher rate of dislocation than those with 1-2 levels.”
“The results were as we expected. We are still unable to determine whether the sequence of lumbar spinal fusion versus THA affects the likelihood of dislocation.”
“Patients with lumbar spinal fusion pose a challenge when undergoing THA owing to their increased risk of dislocation. Further efforts should focus on patient-specific implant positioning in these patients.”
Dr Buckland and team are terrific leaders in this field and to be commended on their study. The issue here is the loss of pelvic motion as a result of the fusion surgery. A successful hip replacement requires a minimum of 7 degrees motion between the sitting and standing positions in order to place a socket that will function well, and the surgeon must know what position the pelvis is stuck in, be it rolled forward or backwards. The components can then be planned in the correct orientation to each other or a specialized socket called a dual mobility component can be used as these are inherently more stable against dislocation than the standard implant.
Hi, I am a 56 year old male from New Zealand. I have endured 11 Lumbar Surgeries, last was in 2018. I originally damaged my Lumbar Spine lifting heavy boulders. Post surgery 2018 I have had increasing pain in my hips. (My surgeon has indicated a number of times I am the worst case currently in New Zealand.) Hips are at the stage I struggle daily to move and was interested to find if there can be anything done to relieve this chronic pain. Is it true that the more surgeries you have, the hip pain increases and less chance of being able to resolve the pain? Would be helpful if someone genuinely could give me an honest answer.
Thankyou
This is scary. I have had 4 separate fusion surgeries over a period of 2012 (Aug 16 anterior fusion L4-S1, Aug 23 posterior fusion L4-S1), 2014 Feb 11 L2-S1 and a do-over Oct 14 2012 (T-10-S1).
Now osteoarthritis in both hips, the left is in an extreme state of near complete failure. I can barely walk after rising in the morning. Without shoes, the pain is extreme. I have a new job, just a few days old now and I know for sure that I need a THP, bilateral but of course not at the same time. Reading over this issue of spinal fusion, in my case multiple fusions, it looks like I am at a much greater risk of post-op complications. I cannot inform a new employer that I need 8-wks off to recover, perhaps longer in my case. So, do you have any objective opinion of someone with multiple fusions, 10 levels and risk of waiting too long to have the surgery? Any opinion is appreciated and of course only my doctor and I can make the final decision. Thank you, Mark MacDonald
I had L4-S1 fusion in 2000. In 2012 I had my right hip replaced. It has dislocated three times. After the second dislocation, one consulting doctor said I was the perfect candidate for it to keep happening. Five months later it happened again. Since I can’t ‘unfuse’ my spine, I am not having the hip redone. Also, what should i do about my left hip? Not ‘quite ready’ yet, but the day may come.
What did you do once it dislocated?? What kind of pain is it?? And what is the solution
I have the same issue spinal fusion in 2015 & rt hip replacement in 2018. First dislocation in 11/2019, second time in 1/2020, third dislocation 6/20.
At this point they decided to do a hip revision, but in doing x-rays & MRI it was noted I needed another fusion that could help prevent a forth dislocation. Had second fusion on 2/21 then dislocated a fourth time in 4/21. Had my hip revision on 6/21, I can feel now that it is more secure & now am having my left hip replacement on 10/21. Hip dislocation is so unbelievably painful, you cannot even move a fraction of an inch without excruciating pain & cramping. Having 100mg of fentanyl barely touched the pain for the 20 min. Ride to the hospital just the vibration caused pain & I have a very high pain threshold…
Hi Lorelei,
I’m so alarmed and sorry to read your story. I found out this week that I need a new hip and spinal fusion.
So now it’s the million dollar question, what comes first my hip or my back. There are 2 schools of thought. My neurosurgeon says my hip first because I’ll heal faster and I need the stability to recover from the spinal surgery. My orthopedic feels a great deal of pain is coming from my back and I should have my spine L4 L5 S1 repaired first, it’s all so overwhelming. Of course the choice is mine and it’s brain damage reading the 2 schools of thought. I’ve already suffered a failed knee replacement that required 6 surgeries. I’m so scared I’m going to make the wrong decision and would appreciate your thoughts. Thank you for your time and I hope your doing well.
Sincerely, Kelly
My wife has undergone lumber fusion L-5, L-4, S-1, Two pedicle screws fractured. 3 1/2 months later she had THA and complained a week after the THA to her surgeon her hip was dislocating. He never believed her and finally kicked her out the door. In 2021 and 2022, she had both hip joints fused. Now nothing moves, no one cares, and the pain has intensified with major numbness in hands feet and arms. They say for the past five years my wife was only after the prescription drugs. That is why I say be weary of who does surgery because if they screw you up, they will cover up everything and it’s a coven that is difficult to breach. Don’t do it is what I say.
Hello, my name is Isolde, in 1999 I had an anterior/interiors fusion with Raycages on my lower back. In the last few years my hips became unstable. My right hip was fused on march1st 2023, it feels soo much better, on may 10th the left hip will get fused as well, they use 3 screws .My balance improved on rt side & no pain in rt hip. Iam almost 60 & there was no better time then now to finally do something about it. I pray that everyone finds a good surgeon that can help them to live a better pain free life. God bless