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Bone Joint J. 2017 May;99-B(5):585-591. doi: 10.1302/0301-620X.99B5.BJJ-2016-0657.R1.

Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion.

Author information

Hospital for Joint Diseases at NYU Langone Medical Center, 306 E. 15th St, New York, NY, 10003, USA.
Johns Hopkins Hospital, 102 Crane Meadow Place, Chapel Hill, NC 27514, USA.
Hospital for Joint Diseases at NYU Langone Medical Center, 301 E.17th St, New York, NY 10003, USA.
Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21205, USA.
University of California - Davis, 4860 Y St, Suite 3800, Sacramento, CA 95817, USA.
Swedish Medical Center, 550 17th Ave, James Tower, 5th Floor, Seattle, WA 98122, USA.
University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA.
University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA.



Lumbar fusion is known to reduce the variation in pelvic tilt between standing and sitting. A flexible lumbo-pelvic unit increases the stability of total hip arthroplasty (THA) when seated by increasing anterior clearance and acetabular anteversion, thereby preventing impingement of the prosthesis. Lumbar fusion may eliminate this protective pelvic movement. The effect of lumbar fusion on the stability of total hip arthroplasty has not previously been investigated.


The Medicare database was searched for patients who had undergone THA and spinal fusion between 2005 and 2012. PearlDiver software was used to query the database by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural code for primary THA and lumbar spinal fusion. Patients who had undergone both lumbar fusion and THA were then divided into three groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The rate of dislocation in each group was established using ICD-9-CM codes. Patients who underwent THA without spinal fusion were used as a control group. Statistical significant difference between groups was tested using the chi-squared test, and significance set at p < 0.05.


At one-year follow-up, 14 747 patients were found to have had a THA after lumbar spinal fusion (12 079 1 to 2 levels, 2594 3 to 7 levels, 74 8+ levels). The control group consisted of 839 004 patients. The dislocation rate in the control group was 1.55%. A higher rate of dislocation was found in patients with a spinal fusion of 1 to 2 levels (2.96%, p < 0.0001) and 3 to 7 levels (4.12%, p < 0.0001). Patients with 3 to 7 levels of fusion had a higher rate of dislocation than patients with 1 to 2 levels of fusion (odds ratio (OR) = 1.60, p < 0.0001). When groups were matched for age and gender to the unfused cohort, patients with 1 to 2 levels of fusion had an OR of 1.93 (95% confidence interval (CI) 1.42 to 2.32, p < 0.001), and those with 3 to 7 levels of fusion an OR of 2.77 (CI 2.04 to 4.80, p < 0.001) for dislocation.


Patients with a previous history of lumbar spinal fusion have a significantly higher rate of dislocation of their THA than age- and gender-matched patients without a lumbar spinal fusion. Cite this article: Bone Joint J 2017;99-B:585-91.


Dislocation; Lumbar fusion; Total hip arthroplasty

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