Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, California.
Health Information Solutions, Rocklin, California.
J Bone Joint Surg Am. 2019 Apr 17;101(8):675-681. doi: 10.2106/JBJS.18.00667.
Previous studies have noted the progression of arthritis due to increased forces in articular structures adjacent to a fused joint. It is unknown whether spinal fusion generates increased forces at the hip joint causing progression to arthritis leading to total hip arthroplasty (THA). We sought to determine (1) is there a relationship between spinal fusion and THA, (2) what are risk factors for subsequent THA, and (3) is there a time interval from spinal fusion to THA?
A large patient discharge dataset was utilized to evaluate all patients who underwent spinal fusion and subsequent THA in California from 2004 through 2013. Patients were categorized by age, sex, hospital type, hospital volume, and number of spinal levels fused. Multivariate analysis was performed to investigate the relationship between spinal fusion and THA. Hazard ratios were calculated for risk factors for THA after spinal fusion. Patients were excluded for previous spinal fusion or hip arthroplasty, inflammatory arthropathy, cancer, and an age of ≤40 years, a surrogate for adolescent and neuromuscular scoliosis.
A total of 101,206 patients underwent spinal fusion; 2,803 (2.77%) subsequently underwent THA. In a bivariate analysis comparing 1 to 2 levels versus >2 levels fused, males had a 17% increased relative risk of undergoing subsequent THA (relative risk [RR] = 1.17; 95% confidence interval [CI] = 1.16 to 1.17) and female patients had a 35% increased relative risk (RR = 1.35; 95% CI = 1.34 to 1.35) when the fusion involved >2 levels. For females, the relative risk increased by 119% when >7 levels were fused compared with 1 to 7 levels (RR = 2.19; 95% CI = 2.16 to 2.21). Using multivariate random-effects analysis, significant risk factors for THA after spinal fusion included female sex (hazard ratio [HR] = 1.21; 95% CI = 1.13 to 1.31; p < 0.0001) and spinal fusion of >7 levels (HR = 1.52; 95% CI = 1.03 to 2.24; p = 0.035).
Patients with longer spinal fusion constructs, especially female patients, had a significantly increased risk of undergoing subsequent THA. Patients should be educated regarding the potential for the progression to hip arthritis after spinal fusion and the possibility of future THA.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
先前的研究指出，由于关节结构邻近融合关节的力增加，关节炎会进展。目前尚不清楚脊柱融合是否会在髋关节产生更大的力，从而导致关节炎进展，进而需要进行全髋关节置换术（THA）。我们试图确定：（1）脊柱融合与 THA 是否存在关联；（2）哪些是后续进行 THA 的危险因素；（3）脊柱融合到 THA 之间是否存在时间间隔。
我们利用一个大型患者出院数据集，评估了 2004 年至 2013 年期间加利福尼亚州所有接受脊柱融合和后续 THA 的患者。患者按年龄、性别、医院类型、医院容量和融合的脊柱节段数进行分类。进行多变量分析以研究脊柱融合与 THA 之间的关系。计算脊柱融合后发生 THA 的危险因素的风险比。排除既往脊柱融合或髋关节置换术、炎症性关节炎、癌症以及年龄≤40 岁（代表青少年和神经肌肉性脊柱侧凸）的患者。
共有 101206 例患者接受了脊柱融合术，其中 2803 例（2.77%）随后接受了 THA。在比较 1 至 2 个节段与>2 个节段融合的双变量分析中，男性随后接受 THA 的相对风险增加了 17%（相对风险 [RR] = 1.17；95%置信区间 [CI] = 1.16 至 1.17），而女性患者的相对风险增加了 35%（RR = 1.35；95% CI = 1.34 至 1.35），当融合涉及>2 个节段时。对于女性，与 1 至 7 个节段相比，融合>7 个节段时，相对风险增加了 119%（RR = 2.19；95% CI = 2.16 至 2.21）。使用多变量随机效应分析，脊柱融合后发生 THA 的显著危险因素包括女性（风险比 [HR] = 1.21；95% CI = 1.13 至 1.31；p < 0.0001）和>7 个节段的脊柱融合（HR = 1.52；95% CI = 1.03 至 2.24；p = 0.035）。
脊柱融合节段较长的患者，尤其是女性患者，随后接受 THA 的风险显著增加。应向患者告知脊柱融合后髋关节关节炎进展和未来可能需要进行 THA 的潜在风险。
治疗性 IV 级。请参阅作者说明以获取完整的证据水平描述。
