The Impact of Total Hip Arthroplasty on Lumbar-Specific Outcomes and Complications in Patients with Lumbar Spinal Fusion: A Systematic Review.

Background: Hip-spine syndrome, characterized by coexisting hip arthritis and degenerative lumbar spine disease, is prevalent in the aging population. While prior research has examined how lumbar spinal fusion (LSF) affects total hip arthroplasty (THA) outcomes, the impact of THA on lumbar-specific outcomes after LSF remains underexplored. This systematic review consolidates evidence on how THA timing and presence influence lumbar-specific outcomes and complications in patients undergoing LSF. To our knowledge, no prior systematic review has been performed on this topic.

Methods: A comprehensive search of 4 databases through January 19, 2024, identified 6 articles for inclusion. Studies were evaluated using the Methodological Index for Non-Randomized Studies scale, with all articles deemed of moderate quality.

Results: Data from 271,008 patients revealed that individuals undergoing THA before LSF exhibited higher Oswestry Disability Index scores and lower Harris Hip Scores than those undergoing THA after LSF. THA performed after LSF was associated with increased risks of adjacent segment disease, pseudarthrosis, revision LSF, and mechanical failure. Additionally, LSF performed within 2 years after THA showed elevated risks of deep vein thrombosis, neurological complications, and prolonged opioid use.

Conclusions: Lumbar-specific complications are increased following concomitant THA and LSF and may be affected by the order the surgeries are performed. Strategic planning of surgical interventions is essential to optimize outcomes for patients with concomitant hip and lumbar spine pathology.