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Study links lumbar-to-sacrum fusions to greater THA dislocation risk, rate

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DALLAS — Patients with a lumbar spine fusion who underwent total hip arthroplasty had a 6% overall dislocation rate vs. a 1% overall dislocation rate in a control group of patients, based on results presented at the American Association of Hip and Knee Surgeons Annual Meeting, here.

Kevin I. Perry

Kevin I. Perry, MD, said in his presentation of the findings, “All these dislocations were early. All occurred in the first 6 months, and none of the dislocations required revision surgery.”

Survivorship free of revision at 10 years was not different between the two groups.

The controls used were patients matched 1:2 to the 59 patients (67 hips) in the fused group based on age, sex, BMI and surgical year of 1998 to 2015.

The fused patients included 27 patients with one-level lumbar fusion, 17 patients with two or more fused lumbar levels and 22 patients with a lumbar fusion to the sacrum.

Anteversion, inclination, approach and femoral head size were not different between any of the three fusion groups, Perry said.

However, he and his colleagues found three of the four dislocations in the fused group were in the group whose lumbar spine was fused to the sacrum.

“Patients with a sacral fusion had the highest risk of dislocation — eight-times higher than their control comparison — and we feel that in these high-risk patients, surgeons should consider using high-stability constructs judiciously. Certainly, at this point in time, future study is necessary to figure out where we should be putting these cups in this high-risk group of patients,” Perry said.

The small study size and that radiographic parameters, like sacral slope and pelvic tilt, were not examined were limitations of the study, he said, adding “That is something we will do before the final paper.” – by Susan M. Rapp

Reference:

Salib CG, et al. Paper #10. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 2-5, 2017; Dallas.

Disclosure: Perry reports no relevant financial disclosures.