Hip osteoarthritis is associated with higher revision rates following transforaminal lumbar interbody fusion.

Abstract

Purpose: Patients with concurrent hip osteoarthritis (OA) and lumbar spinal pathologies often present with more disability and worse baseline measures of pain and function compared to patients with only spinal disease. However, the impact of hip OA on outcomes following specific spinal fusion techniques, such as transforaminal lumbar interbody fusion (TLIF), is not well established.

Methods: Patients with and without hip OA who underwent TLIF at a single academic institution were identified. Patients with total hip arthroplasty were excluded. Baseline demographics, one-year postoperative surgical complications, and preoperative to one-year postoperative change in PROMs were compared. Multivariate regression analysis, accounting for age, sex, and CCI, were performed to evaluate outcomes in hip OA patients.

Results: Among the 234 included patients, 117 had hip OA and 117 did not. The mean age was 63.7 years, 54.3% were females, the mean CCI was 3.2, and the mean follow-up was 30.6 months. Hip OA patients had a higher revision fusion rate compared to non-hip OA patients (19.7% vs. 6.0%, p = 0.002), with 4.18 times higher odds of revision (95% CI = 1.63-10.70, p = 0.003). At one year postoperatively, patients with hip OA had significantly worse VAS Leg scores (5.04 vs. 3.95, p = 0.005) and demonstrated less improvement in VAS Leg (- 1.61 vs. -2.81, p = 0.008) than non-hip OA patients. Other PROMs did not differ significantly between the two groups.

Conclusions: This investigation revealed that patients with hip OA undergoing TLIF have higher revision rates and worse VAS leg pain compared to those without hip OA. This highlights the importance of a comprehensive evaluation and multidisciplinary care of hip and spine disorders in patients undergoing spine surgery, which can guide surgical decision making and patient counselling, with potential to improve postoperative outcomes.