The Majority of Total Hip Arthroplasty Patients With a Stiff Spine Do Not Have an Instrumented Fusion

Abstract

Background: Total hip arthroplasty (THA) patients with limited lumbar flexion (LF) have increased rates of dislocation. An instrumented spinal fusion is a well-recognized cause whose risk increases with increasing number of levels fused. However, many patients without an instrumented fusion (IF) also exhibit abnormal spinopelvic mobility. The purpose of this study was to understand the proportion of THA patients without an IF that have a stiff spine (SS) and behave as if they are surgically fused.

Methods: A retrospective analysis was performed on 6340 primary THA patients, all of whom had preoperative spinopelvic measurements. Any IF of the lumbar spine was observed on the lateral standing radiograph and recorded. SS was classified by LF ≤ 20°, and the percentage of patients with an IF and limited LF was determined.

Results: Three hundred fifty-six (6%) patients had a SS, and only 67 (19%) had an IF. Of the entire 6340 patients, 207 (3%) had an IF. Of these 207, only 67 (32%) had a SS.

Conclusions: The vast majority (81%) of THA patients with a SS do not have an IF. We recommend preoperative spinopelvic assessment of all patients undergoing THA, as only a minority of those with limited LF have an IF and may otherwise be overlooked. Lumbar degenerative disc disease is common in THA patients, limits the available LF in the same way an IF might and potentially increases the risk of dislocation in this subset of patients.

Level of evidence: III.

Keywords: dislocation; instrumented fusion; spine fusion; stiff spine; total hip arthroplasty.