Dislocation Rates of Primary Total Hip Arthroplasty in Patients With Prior Lumbar Spine Fusion and Lumbar Degenerative Disk Disease With and Without Utilization of Dual Mobility Cups: An American Joint Replacement Registry Study.

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Joseph M Nessler, Arthur L Malkani, Patrick J Yep, Kyle J Mullen, Richard L Illgen

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Joseph M Nessler: From the University of Wisconsin, Madison, WI, Department of Orthopedics and Rehabilitation (Nessler), University of Louisville, Louisville, KY, Department of Orthopedics Adult Reconstruction Program (Malkani), American Academy of Orthopaedic Surgeons, Chicago, IL (Yep and Mullen), and Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Adult Reconstruction Program, Madison, WI (Illgen). ORCID

PMID: 36728665 DOI: 10.5435/JAAOS-D-22-00767

INTRODUCTION: Patients undergoing primary total hip arthroplasty (THA) with a previous history of lumbar spine fusion (LSF) are at increased risk of dislocation. The purpose of this study was to compare the 90-day and 1-year dislocation rates of patients with LSF or lumbar degenerative disk disease who underwent primary THA with and without dual mobility (DM) constructs.
METHODS: An American Joint Replacement Registry data set of patients aged 65 years and older undergoing primary THA with minimum 1-year follow-up with a history of prior LSF or a diagnosis of lumbar degenerative disk disease was created. DM status was identified, and dislocation and all-cause revision at 90 days and 1 year were assessed.
RESULTS: A total of 15,572 patients met study criteria. The overall dislocation rates for the non-DM and DM groups were 1.17% and 0.68%, respectively, at 90 days, and 1.68% and 0.91%, respectively, at 1 year ( P = 0.005). The odds of 90-day (OR = 0.578, [ P = 0.0328]) and 1-year (OR = 0.534, [ P = 0.0044]) dislocation were significantly less with DM constructs, compared with non-DM constructs. No statistically significant difference was observed in revision rates between groups.
DISCUSSION: This large registry-based study identified a reduced risk of dislocation in patients at risk for spinal stiffness when a DM compared with non-DM construct was used in primary THA at 90-day and 1-year follow-up intervals. Our data support the use of DM constructs in high-risk patients with stiff spines and altered spinopelvic mobility as a promising option to mitigate the risk of postoperative hip instability after primary THA.
LEVELS OF EVIDENCE: Level III. Therapeutic retrospective cohort.

AAOS: American Joint Replacement Registry Annual Report. Rosemont, IL, American Academy of Orthopaedic Surgeons (AAOS), 2022.

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Humans

United States

Arthroplasty, Replacement, Hip

Hip Dislocation

Retrospective Studies

Reoperation

Joint Dislocations

Intervertebral Disc Degeneration

Registries

Hip Prosthesis

Prosthesis Design

Prosthesis Failure

Journal Article

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