Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
J Arthroplasty. 2023 Jul;38(7S):S106-S113.e1. doi: 10.1016/j.arth.2023.04.038. Epub 2023 Apr 25.
In patients, who have coexisting lumbar spine and degenerative hip disease, there remains uncertainty regarding whether hip or spine surgery should be performed first. We hypothesized that undergoing total hip arthroplasty (THA) would protect against subsequent lumbar spine surgery (LSS) in patients who have 'hip-spine syndrome.'
A retrospective cohort study was performed from 2013 to 2021 on patients who had radiographically-confirmed hip osteoarthritis and degenerative lumbar spine pathology, evaluated separately in spine and arthroplasty clinics prior to surgical intervention. Included patients ultimately underwent THA and/or LSS. The primary outcome was survivorship free of LSS or THA after the other was initially performed.
Of 256 patients, 206 (80.5%) underwent THA first. Only 14 of 206 (6.8%) who underwent THA required subsequent LSS, while 31 of 50 (62%) who underwent LSS required subsequent THA, (P < .001). At 5 years, there was 93.9% survivorship-free of LSS in the THA first group, compared to 44.7% survivorship-free of subsequent THA in the LSS group. Multivariate analyses showed that patients who had THA first had lower odds of undergoing subsequent surgery (odds ratio [OR]: 0.61, CI: 0.52-0.70, P < .001) compared to those who underwent LSS first. Additionally, those who have higher initial Kellgren-Lawrence grade hip osteoarthritis had lower odds (OR: 0.94, CI: 0.89-0.99, P = .04), and those who have progressive neurologic deficits (OR: 2.64, CI: 1.89-3.7, P < .001) and neurogenic claudication (OR: 1.15, CI: 1.06-1.24, P = .001) had increased odds of undergoing subsequent LSS.
Patients with 'hip-spine syndrome' may receive more initial benefit from undergoing THA, potentially reducing the subsequent need for LSS. The exceptions were those patients who had lower-severity hip osteoarthritis and symptoms of major spinal stenosis.
对于同时患有腰椎疾病和退行性髋部疾病的患者，对于髋部手术和脊柱手术的先后顺序仍存在争议。我们假设对于患有“髋-脊柱综合征”的患者，行全髋关节置换术（THA）会降低随后行腰椎手术（LSS）的可能性。
这是一项回顾性队列研究，从 2013 年至 2021 年，对分别在脊柱和关节置换诊所接受影像学确诊的髋关节炎和退行性腰椎脊柱病变评估的患者进行研究。纳入的患者最终接受了 THA 和/或 LSS。主要结果是在初始治疗后，无 LSS 或 THA 再次手术的生存率。
256 例患者中，206 例（80.5%）患者先行 THA。在先行 THA 的 206 例患者中，仅有 14 例（6.8%）需要后续行 LSS，而在先行 LSS 的 50 例患者中，有 31 例（62%）需要后续行 THA（P<.001）。在 5 年时，THA 组无 LSS 再次手术的生存率为 93.9%，而 LSS 组无后续 THA 手术的生存率为 44.7%。多变量分析显示，先行 THA 的患者后续行手术的可能性较低（比值比[OR]：0.61，95%置信区间[CI]：0.52-0.70，P<.001）。此外，Kellgren-Lawrence 髋关节骨关节炎初始分级较高的患者可能性较低（OR：0.94，95%CI：0.89-0.99，P=0.04），进展性神经功能缺损（OR：2.64，95%CI：1.89-3.7，P<.001）和神经性跛行（OR：1.15，95%CI：1.06-1.24，P=0.001）的患者后续行 LSS 的可能性增加。
患有“髋-脊柱综合征”的患者可能会从 THA 中获得更多的早期获益，从而降低后续行 LSS 的需求。例外情况是那些髋关节骨关节炎严重程度较低和有严重脊柱狭窄症状的患者。
