Patients Undergoing Multilevel Thoracolumbar Fusions With Prior Total Hip Arthroplasty Are at Higher Risk for Prosthetic Dislocations.

Authors

• Khoa S Tran
• Mark J Lambrechts
• Yunsoo Lee
• Jonathan Ledesma
• Sandy Li
• Michael Meghpara
• Tristan B Fried
• Luke Kowal
• Hamd Mahmood
• Tariq Z Issa
• Olivia Opara
• Ashley Wong
• Jose A Canseco
• Alan S Hilibrand
• D Greg Anderson
• Alexander R Vaccaro
• Christopher K Kepler
• Gregory D Schroeder

Publication/Presentation Date

11-15-2025

Abstract

BACKGROUND: As the number of patients undergoing both total hip arthroplasty (THA) and lumbar spinal fusion rises, clinicians must gain a stronger understanding of the biomechanical and clinical associations between these two procedures. This study compared single versus multilevel spinal fusion on spinopelvic parameters, clinical outcomes, and THA dislocation rates in patients with existing THAs.

METHODS: Patients with an existing THA undergoing elective spinal fusion were retrospectively identified at a single academic center. Cohorts were stratified by fusion construct length (single or multilevel) and outcomes were followed at least 1 year after surgery.

RESULTS: A total of 392 patients (260 single level, 132 multilevel) were included. Patients who underwent multilevel fusion had less improvement in ∆ visual analogue scale (VAS) Back Scores at 1 year (-1.00 vs. -2.50, P = 0.039), greater hospital length of stay (5.00 vs. 3.00 days, P < 0.001), and lower rates of discharge home (48.5% vs. 81.4%, P < 0.001). They had higher dislocation (4.55% vs. 0.38%, P = 0.007), spinal revision (25.8% vs. 13.5%, P = 0.004), and 90-day readmission rates (12.1% vs. 3.46%, P = 0.002). Radiographically, patients with multilevel constructs had lower preoperative (40.4° vs. 49.1°, P < 0.001), postoperative (43.4° vs. 48.6°, P = 0.004), and 1-year lumbar lordosis (44.4° vs. 50.5°, P = 0.028) and higher postoperative mean anteversion (24.2° vs. 21.0°, P = 0.017). Single-level fusion was an independent predictor for lower VAS leg scores (odds ratio [OR] = -2.57, P = 0.011), fewer readmissions (OR = -0.13, P = 0.001), and fewer complications (OR = -0.25, P < 0.001). Male sex independently predicted increased spinal revisions (OR = 0.13, P = 0.026).

CONCLUSION: Patients with prior THA undergoing multilevel fusions experienced more dislocations, higher spinal revisions, less frequent discharge home, longer hospital length of stays, and higher 90-day readmission rates. They had less improvement in ∆VAS Back Scores at 1 year, lower lumbar lordosis, and greater anteversion. Patients with existing THA undergoing multilevel fusion have more abnormal spinal sagittal balance and higher risk of dislocation despite higher baseline and postoperative acetabular anteversion.

Volume

33

Issue

22

First Page

1343

Last Page

1343

ISSN

1940-5480

Published In/Presented At

Tran, K. S., Lambrechts, M. J., Lee, Y., Ledesma, J., Li, S., Meghpara, M., Fried, T. B., Kowal, L., Mahmood, H., Issa, T. Z., Opara, O., Wong, A., Canseco, J. A., Hilibrand, A. S., Anderson, D. G., Vaccaro, A. R., Kepler, C. K., & Schroeder, G. D. (2025). Patients Undergoing Multilevel Thoracolumbar Fusions With Prior Total Hip Arthroplasty Are at Higher Risk for Prosthetic Dislocations. The Journal of the American Academy of Orthopaedic Surgeons, 33(22), e1343–e1359. https://doi.org/10.5435/JAAOS-D-24-00606

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

39928854

Department(s)

Administration and Leadership

Document Type

Article