Total Hip Arthroplasty After Spinal Fusion Surgery

Abstract

Given the close functional connection between the hip and the spine, their simultaneous degenerative pathology is a common problem seen in orthopedic patients and has been termed the “hip spine syndrome”. Demographic change and an increasing number of operations have led to more patients who have undergone both total hip arthroplasty and spondylodesis especially of the lumbar spine. Studies have shown significant dislocation rates in this cohort of as high as almost 30%. Biomechanical studies and considerations show that spinal surgery directly influences the functional acetabular position and, consequently, the position of the acetabular cup, making the correct implantation challenging for the hip surgeon. Spinal fusion affects not only the biomechanics of the spine but also of the hip joint and, for that reason, must accordingly be taken into account when planning total hip arthroplasty.

Key words

dislocation - total hip arthroplasty - spinal fusion

Publication History

Article published online:
05 June 2019

• References/Literatur

• 1 Phan D, Bederman SS, Schwarzkopf R. The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty. Bone Joint J 2015; 97-B: 1017-1023 doi:10.1302/0301-620x.97b8.35700
• 2 Sing DC, Barry JJ, Aguilar TU. et al. Prior lumbar spinal arthrodesis increases risk of prosthetic-related complication in total hip arthroplasty. J Arthroplasty 2016; 31: 227-232.e1 doi:10.1016/j.arth.2016.02.069
• 3 York PJ, McGee jr. AW, Dean CS. et al. The relationship of pelvic incidence to post-operative total hip arthroplasty dislocation in patients with lumbar fusion. Int Orthop 2018; 42: 2301-2306 doi:10.1007/s00264-018-3955-2
• 4 Bedard NA, Martin CT, Slaven SE. et al. Abnormally high dislocation rates of total hip arthroplasty after spinal deformity surgery. J Arthroplasty 2016; 31: 2884-2885 doi:10.1016/j.arth.2016.07.049
• 5 Lazennec JY, Brusson A, Rousseau MA. Lumbar-pelvic-femoral balance on sitting and standing lateral radiographs. Orthop Traumatol Surg Res 2013; 99 (1 Suppl.): S87-S103 doi:10.1016/j.otsr.2012.12.003
• 6 Mudrick CA, Melvin JS, Springer BD. Late posterior hip instability after lumbar spinopelvic fusion. Arthroplast Today 2015; 1: 25-29 doi:10.1016/j.artd.2015.05.002
• 7 Philippot R, Wegrzyn J, Farizon F. et al. Pelvic balance in sagittal and Lewinnek reference planes in the standing, supine and sitting positions. Orthop Traumatol Surg Res 2009; 95: 70-76 doi:10.1016/j.otsr.2008.01.001
• 8 Rivière C, Lazennec JY, Van Der Straeten C. et al. The influence of spine-hip relations on total hip replacement: A systematic review. Orthop Traumatol Surg Res 2017; 103: 559-568 doi:10.1016/j.otsr.2017.02.014
• 9 Furuhashi H, Togawa D, Koyama H. et al. Repeated posterior dislocation of total hip arthroplasty after spinal corrective long fusion with pelvic fixation. Eur Spine J 2017; 26 (Suppl. 01) S100-S106 doi:10.1007/s00586-016-4880-y
• 10 Hammerberg EM, Wood KB. Sagittal profile of the elderly. J Spinal Disord Tech 2003; 16: 44-50
• 11 Gelb DE, Lenke LG, Bridwell KH. et al. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 1995; 20: 1351-1358
• 12 Boulay C, Tardieu C, Hecquet J. et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 2006; 15: 415-422 doi:10.1007/s00586-005-0984-5
• 13 Legaye J, Duval-Beaupère G, Hecquet J. et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 1998; 7: 99-103 doi:10.1007/s005860050038
• 14 Chevillotte T, Coudert P, Cawley D. et al. Influence of posture on relationships between pelvic parameters and lumbar lordosis: Comparison of the standing, seated, and supine positions. A preliminary study. Orthop Traumatol Surg Res 2018; 104: 565-568 doi:10.1016/j.otsr.2018.06.005
• 15 Lazennec JY, Charlot N, Gorin M. et al. Hip-spine relationship: a radio-anatomical study for optimization in acetabular cup positioning. Surg Radiol Anat 2004; 26: 136-144 doi:10.1007/s00276-003-0195-x
• 16 Okpala FO. Comparison of four radiographic angular measures of lumbar lordosis. J Neurosci Rural Pract 2018; 9: 298-304 doi:10.4103/jnrp.jnrp_508_17
• 17 Harrison DE, Cailliet R, Harrison DD. et al. Reliability of centroid, Cobb, and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine (Phila Pa 1976) 2001; 26: E227-E234
• 18 Lewinnek GE, Lewis JL, Tarr R. et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60: 217-220
• 19 McKibbin B. Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg Br 1970; 52: 148-159
• 20 Dorr LD, Malik A, Dastane M. et al. Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res 2009; 467: 119-127 doi:10.1007/s11999-008-0598-4
• 21 Callanan MC, Jarrett B, Bragdon CR. et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 2011; 469: 319-329 doi:10.1007/s11999-010-1487-1
• 22 Abdel MP, von Roth P, Jennings MT. et al. What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position. Clin Orthop Relat Res 2016; 474: 386-391 doi:10.1007/s11999-015-4432-5
• 23 Kobayashi H, Nakashima Y, Yamamoto T. et al. Late anterior dislocation due to posterior pelvic tilt in total hip arthroplasty. Open Orthop J 2016; 10: 206-212 doi:10.2174/1874325001610010206
• 24 Barry JJ, Yucekul A, Theologis AA. et al. Spinal realignment for adult deformity: three-column osteotomies alter total hip acetabular component positioning. J Am Acad Orthop Surg 2017; 25: 125-132 doi:10.5435/jaaos-d-16-00080
• 25 Honl M, Schwieger K, Gauck CH. et al. Pfannenposition und Orientierung im Vergleich. Orthopäde 2005; 34: 1131-1136 doi:10.1007/s00132-005-0884-8
• 26 Guyen O, Chen QS, Bejui-Hugues J. et al. Unconstrained tripolar hip implants: effect on hip stability. Clin Orthop Relat Res 2007; 455: 202-208 doi:10.1097/01.blo.0000238796.59596.1f
• 27 Philippot R, Camilleri JP, Boyer B. et al. The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years. Int Orthop 2008; 33: 927 doi:10.1007/s00264-008-0589-9
• 28 Malkani AL, Himschoot KJ, Ong KL. et al. Does timing of primary total hip arthroplasty prior to or after lumbar spine fusion have an effect on dislocation and revision rates?. J Arthroplasty 2019;