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Patients with a previous total hip replacement experience less reduction of back pain following lumbar back surgery

Journal article
Authors Ted Eneqvist
Erik Bülow
Szilard Nemes
Helena Brisby
Göran Garellick
P. Fritzell
Ola Rolfson
Published in Journal of Orthopaedic Research
Volume 36
Issue 9
Pages 2484-2490
ISSN 0736-0266
Publication year 2018
Published at Institute of Clinical Sciences, Department of Orthopaedics
Pages 2484-2490
Language en
Links dx.doi.org/10.1002/jor.24018
Keywords lumbar spine surgery, total hip replacement, hip-spine syndrome, patient-reported outcome, spinal stenosis, arthroplasty, outcomes, euroqol, impact, Orthopedics, ott j, 1976, pain, v2, p175
Subject categories Orthopedics

Abstract

The coexistence of degenerative disorders from the hip joint and the lumbar spine, known as the hip-spine syndrome, is a common encounter in clinical practice. These degenerative conditions may cause similar symptoms which often entail diagnostic challenges in determining the origin of pain. Lumbar back surgery (LBS) with fusion and/or decompression, and total hip replacement (THR) are both often successful interventions. However, the knowledge is limited about the post-operative patient-reported outcome (PRO) following LBS in the presence of a prior THR. The aims of this study were to compare 1-year post-operative patient-reported outcome measures (PROMs) following lumbar back surgery (LBS) in patients with and without a prior total hip replacement (THR). Data from Swespine and the Swedish Hip Arthroplasty Register were linked in order to identify the study group of patients with THR prior to LBS. The study group (n=220) and a matched control group (n=220) with isolated LBS was defined by using a step-wise selection process. Linear- and logistic regression analyses adjusted for age, sex and pre-operative PROMs demonstrated that THR prior to LBS was associated with worse back-pain (VAS) at 1-year follow-up (B=5.3, 95%CI: 0.3;10.3). However, previous THR did not influence the EQ-5D index (B=0.01, 95%CI: -0.05;0.06), EQ VAS (B=-3.0, 95%CI: -6.9;1.0), leg pain (B=1.5, 95%CI: -4.0;7.0), Oswestry Disability Index (B=2.6, 95%CI: -0.5;5.6) or satisfaction (OR=1.1, 97.5%CI 0.7;1.6). This knowledge is important to communicate prior to LBS in order to set proper expectations on surgical outcomes. (c) 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2484-2490, 2018.

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