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. 2024 Jul 3;106(13):1171-1180.
doi: 10.2106/JBJS.23.00818. Epub 2024 Apr 29.

Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes

Bassel G Diebo  1 , Daniel Alsoof  1 , Mariah Balmaceno-Criss  1 , Mohammad Daher  1 , Renaud Lafage  2 , Peter G Passias  3 , Christopher P Ames  4 , Christopher I Shaffrey  5 , Douglas C Burton  6 , Vedat Deviren  4 , Breton G Line  7 , Alex Soroceanu  8 , D Kojo Hamilton  9 , Eric O Klineberg  10 , Gregory M Mundis  11 , Han Jo Kim  12 , Jeffrey L Gum  13 , Justin S Smith  14 , Juan S Uribe  15 , Khaled M Kebaish  16 , Munish C Gupta  17 , Pierce D Nunley  18 , Robert K Eastlack  11 , Richard Hostin  19 , Themistocles S Protopsaltis  3 , Lawrence G Lenke  20 , Robert A Hart  21 , Frank J Schwab  2 , Shay Bess  7 , Virginie Lafage  2 , Alan H Daniels  1 ; International Spine Study Group
Collaborators, Affiliations

Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes

Bassel G Diebo et al. J Bone Joint Surg Am. .

Abstract

Background: Hip osteoarthritis (OA) is common in patients with adult spinal deformity (ASD). Limited data exist on the prevalence of hip OA in patients with ASD, or on its impact on baseline and postoperative alignment and patient-reported outcome measures (PROMs). Therefore, this paper will assess the prevalence and impact of hip OA on alignment and PROMs.

Methods: Patients with ASD who underwent L1-pelvis or longer fusions were included. Two independent reviewers graded hip OA with the Kellgren-Lawrence (KL) classification and stratified it by severity into non-severe (KL grade 1 or 2) and severe (KL grade 3 or 4). Radiographic parameters and PROMs were compared among 3 patient groups: Hip-Spine (hip KL grade 3 or 4 bilaterally), Unilateral (UL)-Hip (hip KL grade 3 or 4 unilaterally), or Spine (hip KL grade 1 or 2 bilaterally).

Results: Of 520 patients with ASD who met inclusion criteria for an OA prevalence analysis, 34% (177 of 520) had severe bilateral hip OA and unilateral or bilateral hip arthroplasty had been performed in 8.7% (45 of 520). A subset of 165 patients had all data components and were examined: 68 Hip-Spine, 32 UL-Hip, and 65 Spine. Hip-Spine patients were older (67.9 ± 9.5 years, versus 59.6 ± 10.1 years for Spine and 65.8 ± 7.5 years for UL-Hip; p < 0.001) and had a higher frailty index (4.3 ± 2.6, versus 2.7 ± 2.0 for UL-Hip and 2.9 ± 2.0 for Spine; p < 0.001). At 1 year, the groups had similar lumbar lordosis, yet the Hip-Spine patients had a worse sagittal vertebral axis (SVA) measurement (45.9 ± 45.5 mm, versus 25.1 ± 37.1 mm for UL-Hip and 19.0 ± 39.3 mm for Spine; p = 0.001). Hip-Spine patients also had worse Veterans RAND-12 Physical Component Summary scores at baseline (25.7 ± 9.3, versus 28.7 ± 9.8 for UL-Hip and 31.3 ± 10.5 for Spine; p = 0.005) and 1 year postoperatively (34.5 ± 11.4, versus 40.3 ± 10.4 for UL-Hip and 40.1 ± 10.9 for Spine; p = 0.006).

Conclusions: This study of operatively treated ASD revealed that 1 in 3 patients had severe hip OA bilaterally. Such patients with severe bilateral hip OA had worse baseline SVA and PROMs that persisted 1 year following ASD surgery, despite correction of lordosis.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: Funding for this study was received from DePuy Synthes Spine, NuVasive, and K2/Stryker. In addition, the International Spine Study Group reports grants to the foundation from Medtronic, Globus, Stryker, SI Bone, and Carlsmed. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H962).

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