Orthopaedic Department, Mid-Central District Health Board, Palmerston North, New Zealand.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
Bone Joint J. 2020 Jun;102-B(6):664-670. doi: 10.1302/0301-620X.102B6.BJJ-2019-1473.R1.
There is inconsistent evidence on whether prior spinal fusion surgery adversely impacts outcomes following total hip arthroplasty (THA). We conducted a systematic review and meta-analysis to assess the association between pre-existing spinal fusion surgery and the rate of complications following primary THA.
We searched MEDLINE, Embase, Web of Science, and Cochrane Library up to October 2019 for randomized controlled trials (RCTs) and observational studies comparing outcomes of dislocation, revision, or reasons for revision in patients following primary THA with or without pre-existing spinal fusion surgery. Furthermore, we compared short (two or less levels) or long (three or more levels) spinal fusions to no fusion. Summary measures of association were relative risks (RRs) (with 95% confidence intervals (CIs)).
We identified ten articles corresponding to nine unique observational studies comprising of 1,992,366 primary THAs. No RCTs were identified. There were 32,945 cases of spinal fusion and 1,752,362 non-cases. Comparing prior spinal fusion versus no spinal fusion in primary THA, RRs (95% CI) for dislocation was 2.23 (1.81 to 2.74; seven studies), revision 2.14 (1.63 to 2.83; five studies), periprosthetic joint infection 1.71 (1.53 to 1.92; four studies), periprosthetic fracture 1.52 (1.28 to 1.81; three studies), aseptic loosening 1.76 (1.54 to 2.01; three studies), and any complications 2.82 (1.37 to 5.80; three studies) were identified. Both short and long spinal fusions, when compared with no fusion, were associated dislocation, revision, or reasons for revision.
Patients with prior spinal fusion are at risk of adverse events following primary THA. Measures that reduce the risk of these complications should be considered in this high-risk population when undergoing primary THA. These patients should also be counselled appropriately around their risks of undergoing THA. Cite this article: 2020;102-B(6):664-670.
先前的脊柱融合手术是否会对全髋关节置换术（THA）后的结果产生不利影响，目前尚无定论。我们进行了一项系统评价和荟萃分析，以评估预先存在的脊柱融合手术与初次 THA 后并发症发生率之间的关系。
我们检索了 MEDLINE、Embase、Web of Science 和 Cochrane Library，以获取截至 2019 年 10 月比较初次 THA 后存在或不存在预先脊柱融合手术患者脱位、翻修或翻修原因的随机对照试验（RCT）和观察性研究。此外，我们比较了短（两个或以下水平）或长（三个或以上水平）脊柱融合与无融合的情况。关联的汇总度量指标为相对风险（RR）（95%置信区间（CI））。
我们确定了十篇文章，对应于九项独特的观察性研究，包括 1992366 例初次 THA。未发现 RCT。有 32945 例脊柱融合病例和 1752362 例非融合病例。在初次 THA 中，与无脊柱融合相比，先前脊柱融合的 RR（95%CI）为脱位 2.23（1.81 至 2.74；七项研究）、翻修 2.14（1.63 至 2.83；五项研究）、假体周围关节感染 1.71（1.53 至 1.92；四项研究）、假体周围骨折 1.52（1.28 至 1.81；三项研究）、无菌性松动 1.76（1.54 至 2.01；三项研究）和任何并发症 2.82（1.37 至 5.80；三项研究）。与无融合相比，短和长脊柱融合均与脱位、翻修或翻修原因相关。
先前有脊柱融合的患者在初次 THA 后发生不良事件的风险增加。在接受初次 THA 时，应考虑在这个高危人群中采取降低这些并发症风险的措施。在考虑初次 THA 时，还应适当告知这些患者的风险。引用本文：2020；102-B（6）：664-670。
