Coexistent lumbar spine disorders have a crucial impact on the clinical outcome after total hip replacement.
BACKGROUND
Degenerative hip and spine disease are known to frequently coexist. Lumbar spine disorders (LSDs), as opposed to other patient-related factors, are disregarded in the assessment of the clinical outcome after total hip replacement (THR). This prospective study investigates the influence of LSDs on the pre- and postoperative health-related quality of life and functional outcome of patients undergoing THR.


METHODS
According to clearly defined criteria, 42 patients scheduled for cementless THR were assigned either to the LSD (13 patients with LSDs) or non-LSD group (29 patients without LSDs). A clinical assessment was performed preoperatively as well as 12, 24 and 60 months postoperatively using the Harris hip score (HHS), the Western Ontario and McMaster University osteoarthritis index (WOMAC) and the 36-item short form health survey (SF-36).


RESULTS
The statistical analysis comparing the pre- and postoperative status within both groups showed an ongoing improvement of mean HHS and WOMAC after THR. The non-LSD group had a significantly higher postoperative HHS and WOMAC after 12, 24 and 60 months as well as SF-36 after 24 and 60 months. The LSD group improved significantly in the HHS at 24 and 60 months and the WOMAC at 12, 24 and 60 months postoperatively, whereas the SF-36 improvement was not significant. Comparison of preoperative data in both groups revealed a significantly higher SF-36 in the non-LSD group but no difference between the HHS and WOMAC. At each postoperative assessment, the HHS, WOMAC and SF-36, including its physical and mental health sum scores, were significantly higher in the non-LSD group, except for the WOMAC after 60 months.


CONCLUSIONS
Owing to their crucial impact on hip function scores and health-related quality of life, it is recommended to consider LSDs preoperatively in studies dealing with the clinical outcome after THR.
Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18055, Rostock, Germany. martin.ellenrieder@uni-rostock.de.
Martin
M
Ellenrieder
Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18055, Rostock, Germany.
Rainer
R
Bader
Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18055, Rostock, Germany.
Philipp
P
Bergschmidt
Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18055, Rostock, Germany.
Susanne
S
Fröhlich
Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18055, Rostock, Germany.
Wolfram
W
Mittelmeier
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D010147:Pain Measurement; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012016:Reference Values; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome