Impact of Lower Extremity Arthroplasty on Improvement of Quality-of-Life Outcomes Following Lumbar Fusion.

BACKGROUND

Both hip-spine and knee-spine syndromes can significantly impact a patient's quality of life; however, few studies have investigated their effect on postoperative outcomes following lumbar fusion.

OBJECTIVE

Our study aimed to evaluate the impact of a prior lower extremity arthroplasty on the improvement of patient-reported outcome measures (PROMs) following lumbar fusion surgery.

METHODS

Patients undergoing primary, single, or multilevel lumbar interbody fusion were retrospectively reviewed. Patients missing preoperative PROMs were excluded. PROMs were collected preoperatively and postoperatively and included the Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary, Patient-Reported Outcomes Measurement Information System Physical Function, and visual analog scale (VAS). A minimum clinically important difference (MCID) was calculated. Patients were categorized based on a history of hip/knee arthroplasty and propensity score matched. Intragroup improvement of PROM scores and intergroup differences in mean scores were evaluated using a paired test and linear regression. MCID achievement differences were evaluated using logistic regression.

RESULTS

A total of 335 patients were included, with 25 having a history of hip/knee arthroplasty. Arthroplasty patients were significantly older ( = 0.001) and typically had a higher Charlson Comorbidity Index ( ≤ 0.003, both). Patients differed in spinal pathology of degenerative spondylolisthesis ( = 0.049). Nonarthroplasty patients demonstrated significant improvements in all PROMs by 2 years ( < 0.001, all). The arthroplasty group demonstrated significant improvements in all PROMs by 1 year ( < 0.031, all). Preoperative VAS back was significantly worse for nonarthroplasty patients ( = 0.035). MCID achievement did not significantly differ between groups except at 6 months for ODI ( = 0.035).

CONCLUSION

Following lumbar fusion, patients with a past surgical history did not demonstrate differences in outcome measures or MCID from those without. These results suggest that comorbid orthopedic conditions requiring surgery do not negatively impact the ability of patients to improve following lumbar fusion.

CLINICAL RELEVANCE

Prior surgical history of lower extremity arthroplasty should not discourage the use of lumbar fusion when properly indicated, as patients reported clinical improvement regardless of history of hip or knee arthroplasty.