Sing David C, Barry Jeffrey J, Aguilar Thomas U, Theologis Alexander A, Patterson Joseph T, Tay Bobby K, Vail Thomas P, Hansen Erik N
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
J Arthroplasty. 2016 Sep;31(9 Suppl):227-232.e1. doi: 10.1016/j.arth.2016.02.069. Epub 2016 Mar 15.
Degenerative hip disorders often coexist with degenerative changes of the lumbar spine. Limited data on this patient population suggest inferior functional improvement and pain relief after surgical management. The purpose of this study is to compare the rates of prosthetic-related complication after primary total hip arthroplasty (THA) in patients with and without prior lumbar spine arthrodesis (SA).
Medicare patients (n = 811,601) undergoing primary THA were identified and grouped by length of prior SA (no fusion, 1-2 levels fused [S-SAHA], and ≥3 levels fused [L-SAHA]).
Compared with controls, patients with prior SA had significantly higher rates of complications including dislocation (control: 2.36%; S-SAHA: 4.26%; and L-SAHA: 7.51%), revision (control: 3.43%, S-SAHA: 5.55%, and L-SAHA: 7.77%), loosening (control: 1.33%, S-SAHA: 2.10%, and L-SAHA: 3.04%), and any prosthetic-related complication (control: 7.33%, S-SAHA: 11.15% [relative risk: 1.52], and L-SAHA: 14.16% [relative risk: 1.93]) within 24 months (P < .001).
The interplay of coexisting degenerative hip and spine disease deserves further attention of both arthroplasty and spine surgeons.
退行性髋关节疾病常与腰椎的退行性改变并存。关于这一患者群体的有限数据表明，手术治疗后功能改善和疼痛缓解效果较差。本研究的目的是比较初次全髋关节置换术（THA）后有和没有既往腰椎融合术（SA）的患者中假体相关并发症的发生率。
确定接受初次THA的医疗保险患者（n = 811,601），并根据既往SA的长度进行分组（无融合、1 - 2节段融合[S - SAHA]和≥3节段融合[L - SAHA]）。
与对照组相比，既往有SA的患者并发症发生率显著更高，包括脱位（对照组：2.36%；S - SAHA组：4.26%；L - SAHA组：7.51%）、翻修（对照组：3.43%，S - SAHA组：5.55%，L - SAHA组：7.77%）、松动（对照组：1.33%，S - SAHA组：2.10%，L - SAHA组：3.04%）以及24个月内任何假体相关并发症（对照组：7.33%，S - SAHA组：11.15%[相对风险：1.52]，L - SAHA组：14.16%[相对风险：1.93]）（P <.001）。
并存的退行性髋关节和脊柱疾病之间的相互作用值得关节置换外科医生和脊柱外科医生进一步关注。
