Outcomes following primary total hip replacement with pre-existing spinal fusion surgery: A systematic review and meta-analysis of observational evidence

Presenter’s name (Last, First): Wyatt, Michael

Qualifications: BSc MBChB MD MFSTEd FRCSEd FRACS(Orth)

Affiliations: Massey University

Other authors:
Kunutsor S/PhD/University of Bristol; Beswick A/MSc/University of Bristol; Whitehouse M/PhD FRCS(Tr&Orth)/University of Bristol; Kieser D/PhD FRACS(Orth)/University of Otago

Email: michaelcharleswyatt@icloud.com

Background / Introduction:
There is inconsistent evidence on whether prior spinal fusion surgery adversely impacts outcomes following total hip replacement (THR). We conducted a systematic review and meta-analysis to assess complications of primary THR with or without pre-existing spinal fusion surgery.

Patients / Methods:

We searched MEDLINE, Embase, Web of Science, and Cochrane Library to October 2019 for randomised controlled trials (RCTs) and observational studies comparing outcomes of dislocation, revision, or reasons for revision in patients following primary THR with or without pre-existing spinal fusion surgery. Summary measures of association were relative risks (RRs) (with 95% confidence intervals, CIs).


We identified 10 articles corresponding to 9 unique observational studies comprising of 1,992,366 primary THRs. Comparing prior spinal fusion vs no spinal fusion in primary THR, RRs (95% CIs) for dislocation (7 studies), revision (5 studies), PJI (4 studies), periprosthetic fracture (3 studies), loosening (3 studies), and any complications (3 studies) were 2.23 (1.81-2.74), 2.14 (1.63-2.83), 1.71 (1.53-1.92), 1.52 (1.28-1.81), 1.76 (1.54-2.01), and 2.82 (1.37-5.80) respectively. Short or long spinal fusion when compared with no fusion was also associated with dislocation, revision, or reasons for revision.


Patients with prior spinal fusion are at substantial risk of adverse events following primary THR. Measures that reduce the risk of these complications should be used in this high-risk populations when undergoing primary THR. These patients should also be counselled appropriately around their risks of undergoing THR.

Level of Evidence & Study type: Level II

Declarations of Conflict: No conflicts of interest