Hip-lumbar mobility loss affects quality of life in patients undergoing both lumbar fusion and total hip arthroplasty.

Abstract

Aims: Overall sagittal flexion is restricted in patients who have undergone both lumbar fusion and total hip arthroplasty (THA). However, it is not evident to what extent this movement is restricted in these patients and how this influences quality of life (QoL). The purpose of this study was to determine the extent to which hip-lumbar mobility is decreased in these patients, and how this affects their QoL score.

Methods: Patients who underwent primary THA at our hospital between January 2010 and March 2021 were considered (n = 976). Among them, 44 patients who underwent lumbar fusion were included as cases, and 44 THA patients without lumbar disease matched by age, sex, and BMI as Control T. Among those who underwent lumbar fusion, 44 patients without hip abnormalities matched by age, sex, and BMI to the cases were considered as Control F. Outcome and spinopelvic parameters were measured radiologically in extension and flexed-seated positions. Hip, lumbar, and hip-lumbar mobility were calculated as parameter changes between positions.

Results: There were 20 male and 112 female patients in the case and control groups, with a mean age of 77 years (5 to 94) and a mean BMI of 24 kg/m² (15 to 34). QoL score and hip-lumbar mobility were reduced in cases compared to Control T and F, and were further reduced as the number of fused levels increased. Hip-lumbar mobility was associated with reduction in activity-related QoL, mostly for those activities requiring sagittal flexion.

Conclusion: This study confirmed that hip-lumbar mobility is a factor that influences activity, most of all those requiring overall sagittal flexion. Clinicians should focus on hip-lumbar mobility and counteract disability by suggesting appropriate assistive devices.