Subscribe Now
Forgot Password?

Weekly News, Analysis, and Commentary

Large Joints Feature

Source: Wikimedia commons and Cindy Funk

Lumbar Spinal Fusion Increases Hip Dislocation Risk

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, May 8th, 2017

Print this article

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.”

Send to a Friend

The article link will be sent to the email address you provide

Your Name (required)

Your Email (required)

Friend's Email (required)

Comments

2 Responses to “Lumbar Spinal Fusion Increases Hip Dislocation Risk”

  1. Russell Bodner says:

    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.

  2. 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

Leave a Reply

Name

Email Address (will not be published)

Website

Comment: