Female Sex and Longer Fusion Constructs Significantly Increase the Risk of Total Hip Arthroplasty Following Spinal Fusion

Zachary C. Lum, Eric Otto Klineberg, Beate Danielsen, Mauro Giordani, John Meehan

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Previous studies have noted the progression of arthritis due to increased forces in articular structures adjacent to a fused joint. It is unknown whether spinal fusion generates increased forces at the hip joint causing progression to arthritis leading to total hip arthroplasty (THA). We sought to determine (1) is there a relationship between spinal fusion and THA, (2) what are risk factors for subsequent THA, and (3) is there a time interval from spinal fusion to THA? METHODS: A large patient discharge dataset was utilized to evaluate all patients who underwent spinal fusion and subsequent THA in California from 2004 through 2013. Patients were categorized by age, sex, hospital type, hospital volume, and number of spinal levels fused. Multivariate analysis was performed to investigate the relationship between spinal fusion and THA. Hazard ratios were calculated for risk factors for THA after spinal fusion. Patients were excluded for previous spinal fusion or hip arthroplasty, inflammatory arthropathy, cancer, and an age of ≤40 years, a surrogate for adolescent and neuromuscular scoliosis. RESULTS: A total of 101,206 patients underwent spinal fusion; 2,803 (2.77%) subsequently underwent THA. In a bivariate analysis comparing 1 to 2 levels versus >2 levels fused, males had a 17% increased relative risk of undergoing subsequent THA (relative risk [RR] = 1.17; 95% confidence interval [CI] = 1.16 to 1.17) and female patients had a 35% increased relative risk (RR = 1.35; 95% CI = 1.34 to 1.35) when the fusion involved >2 levels. For females, the relative risk increased by 119% when >7 levels were fused compared with 1 to 7 levels (RR = 2.19; 95% CI = 2.16 to 2.21). Using multivariate random-effects analysis, significant risk factors for THA after spinal fusion included female sex (hazard ratio [HR] = 1.21; 95% CI = 1.13 to 1.31; p < 0.0001) and spinal fusion of >7 levels (HR = 1.52; 95% CI = 1.03 to 2.24; p = 0.035). CONCLUSIONS: Patients with longer spinal fusion constructs, especially female patients, had a significantly increased risk of undergoing subsequent THA. Patients should be educated regarding the potential for the progression to hip arthritis after spinal fusion and the possibility of future THA. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)675-681
Number of pages7
JournalThe Journal of bone and joint surgery. American volume
Volume101
Issue number8
DOIs
StatePublished - Apr 17 2019

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Spinal Fusion
Arthroplasty
Hip
Confidence Intervals
Arthritis
Joints
Patient Discharge
Joint Diseases
Sex Ratio
Hip Joint
Scoliosis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{faf623ea24be4927b9a9af98541b2106,
title = "Female Sex and Longer Fusion Constructs Significantly Increase the Risk of Total Hip Arthroplasty Following Spinal Fusion",
abstract = "BACKGROUND: Previous studies have noted the progression of arthritis due to increased forces in articular structures adjacent to a fused joint. It is unknown whether spinal fusion generates increased forces at the hip joint causing progression to arthritis leading to total hip arthroplasty (THA). We sought to determine (1) is there a relationship between spinal fusion and THA, (2) what are risk factors for subsequent THA, and (3) is there a time interval from spinal fusion to THA? METHODS: A large patient discharge dataset was utilized to evaluate all patients who underwent spinal fusion and subsequent THA in California from 2004 through 2013. Patients were categorized by age, sex, hospital type, hospital volume, and number of spinal levels fused. Multivariate analysis was performed to investigate the relationship between spinal fusion and THA. Hazard ratios were calculated for risk factors for THA after spinal fusion. Patients were excluded for previous spinal fusion or hip arthroplasty, inflammatory arthropathy, cancer, and an age of ≤40 years, a surrogate for adolescent and neuromuscular scoliosis. RESULTS: A total of 101,206 patients underwent spinal fusion; 2,803 (2.77{\%}) subsequently underwent THA. In a bivariate analysis comparing 1 to 2 levels versus >2 levels fused, males had a 17{\%} increased relative risk of undergoing subsequent THA (relative risk [RR] = 1.17; 95{\%} confidence interval [CI] = 1.16 to 1.17) and female patients had a 35{\%} increased relative risk (RR = 1.35; 95{\%} CI = 1.34 to 1.35) when the fusion involved >2 levels. For females, the relative risk increased by 119{\%} when >7 levels were fused compared with 1 to 7 levels (RR = 2.19; 95{\%} CI = 2.16 to 2.21). Using multivariate random-effects analysis, significant risk factors for THA after spinal fusion included female sex (hazard ratio [HR] = 1.21; 95{\%} CI = 1.13 to 1.31; p < 0.0001) and spinal fusion of >7 levels (HR = 1.52; 95{\%} CI = 1.03 to 2.24; p = 0.035). CONCLUSIONS: Patients with longer spinal fusion constructs, especially female patients, had a significantly increased risk of undergoing subsequent THA. Patients should be educated regarding the potential for the progression to hip arthritis after spinal fusion and the possibility of future THA. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.",
author = "Lum, {Zachary C.} and Klineberg, {Eric Otto} and Beate Danielsen and Mauro Giordani and John Meehan",
year = "2019",
month = "4",
day = "17",
doi = "10.2106/JBJS.18.00667",
language = "English (US)",
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journal = "Journal of Bone and Joint Surgery - American Volume",
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TY - JOUR

T1 - Female Sex and Longer Fusion Constructs Significantly Increase the Risk of Total Hip Arthroplasty Following Spinal Fusion

AU - Lum, Zachary C.

AU - Klineberg, Eric Otto

AU - Danielsen, Beate

AU - Giordani, Mauro

AU - Meehan, John

PY - 2019/4/17

Y1 - 2019/4/17

N2 - BACKGROUND: Previous studies have noted the progression of arthritis due to increased forces in articular structures adjacent to a fused joint. It is unknown whether spinal fusion generates increased forces at the hip joint causing progression to arthritis leading to total hip arthroplasty (THA). We sought to determine (1) is there a relationship between spinal fusion and THA, (2) what are risk factors for subsequent THA, and (3) is there a time interval from spinal fusion to THA? METHODS: A large patient discharge dataset was utilized to evaluate all patients who underwent spinal fusion and subsequent THA in California from 2004 through 2013. Patients were categorized by age, sex, hospital type, hospital volume, and number of spinal levels fused. Multivariate analysis was performed to investigate the relationship between spinal fusion and THA. Hazard ratios were calculated for risk factors for THA after spinal fusion. Patients were excluded for previous spinal fusion or hip arthroplasty, inflammatory arthropathy, cancer, and an age of ≤40 years, a surrogate for adolescent and neuromuscular scoliosis. RESULTS: A total of 101,206 patients underwent spinal fusion; 2,803 (2.77%) subsequently underwent THA. In a bivariate analysis comparing 1 to 2 levels versus >2 levels fused, males had a 17% increased relative risk of undergoing subsequent THA (relative risk [RR] = 1.17; 95% confidence interval [CI] = 1.16 to 1.17) and female patients had a 35% increased relative risk (RR = 1.35; 95% CI = 1.34 to 1.35) when the fusion involved >2 levels. For females, the relative risk increased by 119% when >7 levels were fused compared with 1 to 7 levels (RR = 2.19; 95% CI = 2.16 to 2.21). Using multivariate random-effects analysis, significant risk factors for THA after spinal fusion included female sex (hazard ratio [HR] = 1.21; 95% CI = 1.13 to 1.31; p < 0.0001) and spinal fusion of >7 levels (HR = 1.52; 95% CI = 1.03 to 2.24; p = 0.035). CONCLUSIONS: Patients with longer spinal fusion constructs, especially female patients, had a significantly increased risk of undergoing subsequent THA. Patients should be educated regarding the potential for the progression to hip arthritis after spinal fusion and the possibility of future THA. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - BACKGROUND: Previous studies have noted the progression of arthritis due to increased forces in articular structures adjacent to a fused joint. It is unknown whether spinal fusion generates increased forces at the hip joint causing progression to arthritis leading to total hip arthroplasty (THA). We sought to determine (1) is there a relationship between spinal fusion and THA, (2) what are risk factors for subsequent THA, and (3) is there a time interval from spinal fusion to THA? METHODS: A large patient discharge dataset was utilized to evaluate all patients who underwent spinal fusion and subsequent THA in California from 2004 through 2013. Patients were categorized by age, sex, hospital type, hospital volume, and number of spinal levels fused. Multivariate analysis was performed to investigate the relationship between spinal fusion and THA. Hazard ratios were calculated for risk factors for THA after spinal fusion. Patients were excluded for previous spinal fusion or hip arthroplasty, inflammatory arthropathy, cancer, and an age of ≤40 years, a surrogate for adolescent and neuromuscular scoliosis. RESULTS: A total of 101,206 patients underwent spinal fusion; 2,803 (2.77%) subsequently underwent THA. In a bivariate analysis comparing 1 to 2 levels versus >2 levels fused, males had a 17% increased relative risk of undergoing subsequent THA (relative risk [RR] = 1.17; 95% confidence interval [CI] = 1.16 to 1.17) and female patients had a 35% increased relative risk (RR = 1.35; 95% CI = 1.34 to 1.35) when the fusion involved >2 levels. For females, the relative risk increased by 119% when >7 levels were fused compared with 1 to 7 levels (RR = 2.19; 95% CI = 2.16 to 2.21). Using multivariate random-effects analysis, significant risk factors for THA after spinal fusion included female sex (hazard ratio [HR] = 1.21; 95% CI = 1.13 to 1.31; p < 0.0001) and spinal fusion of >7 levels (HR = 1.52; 95% CI = 1.03 to 2.24; p = 0.035). CONCLUSIONS: Patients with longer spinal fusion constructs, especially female patients, had a significantly increased risk of undergoing subsequent THA. Patients should be educated regarding the potential for the progression to hip arthritis after spinal fusion and the possibility of future THA. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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