title: Prosthetic Dislocation and Revision After Primary Total Hip Arthroplasty in Lumbar Fusion Patients: A Propensity Score Matched-Pair Analysis.
abstract: Lumbar-pelvic fusion reduces the variation in pelvic tilt in functional situations by reducing lumbar spine flexibility, which is thought to be important in maintaining stability of a total hip arthroplasty (THA). We compared dislocation and revision rates for patients with lumbar fusion and subsequent THA to a matched comparison cohort with hip and spine degenerative changes undergoing only THA.
  
  
  
  We identified patients in New York State who underwent primary elective lumbar fusion for degenerative disc disease pathology and subsequent THA between January 2005 and December 2012. A propensity score match was performed to compare 934 patients with prior lumbar fusion to 934 patients with only THA according to age, gender, race, Deyo comorbidity score, year of surgery, and surgeon volume. Revision and dislocation rates were assessed at 3, 6, and 12 months post-THA.
  
  
  
  At 12 months, patients with prior lumbar fusion had significantly increased rates of THA dislocation (control: 0.4%; fusion: 3.0%; P < .001) and revision (control: 0.9%; fusion: 3.9%; P < .001). At 12 months, fusion patients were 7.19 times more likely to dislocate their THA (P < .001) and 4.64 times more likely to undergo revision (P < .001).
  
  
  
  Patients undergoing lumbar fusion and subsequent THA have significantly higher risks of dislocation and revision of their hip arthroplasty than a matched cohort of patients with similar hip and spine pathology but only undergoing THA. During preoperative consultation for patients with prior lumbar fusion, orthopedic surgeons must educate the patient and family about the increased risk of dislocation and revision.
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York; Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Dean C
authors.initials: DC
authors.lastname: Perfetti
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Buckland
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Carl B
authors.initials: CB
authors.lastname: Paulino
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Vigdorchik
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D015331:Cohort Studies; D005260:Female; D006617:Hip Dislocation; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009518:New York; D057216:Propensity Score; D011475:Prosthesis Failure; D012044:Regression Analysis; D012086:Reoperation; D013123:Spinal Fusion; D016896:Treatment Outcome
keywords: degenerative spine disease; dislocation; instability; lumbar fusion; revision; total hip arthroplasty