Hips at Higher Risk After Spinal Deformities
September 05, 2019
A recently published study has shown that individuals with lower back problems also have hip issues. The study, published in the August 10, 2019, edition of The Journal of Arthroplasty, takes on the hip-spine relationship and the potential for hip dislocation after total hip replacement surgery.
While hip replacement surgery is a very common - and often very successful - procedure with very low complication rates, some individuals are at risk during the procedure.
These individuals include those with spinal deformities, such as scoliosis, and spinal stiffness - often related to previous lumbar fusion or other causes.
During the study, researchers analyzed an extensive multicenter database of preoperative total hip arthroplasty patients and separated individuals with anterior pelvic plane tilt (APPt), spinopelvic tilt (SPT) and lumbar lordosis (LL).
Next, they measured the rates of pelvic issue incidence using computed tomography scans. They determined the degree of pelvic incidence to be between -10° to 10°.
The researchers found that among the 1,088 study participants, the researchers found that only 59 percent of patients had balanced alignment.
Sixteen percent had lumbar lordosis mismatch greater than 10°, and 4 percent of patients in the study had a PI-LL of more than 20°.
They also found that about 25 percent of the patients had hyperlordosis, a condition that causes an excessive inward curvature in the lower back.
The researchers also noted that individuals with a flat back were often older than those with a balanced spine and those who had hyperlordosis.
The research team found that individuals with a spinal deformity had a greater risk of hip replacement complications than those with balanced spines.
That is why it is important to let your doctor know if you have a history of scoliosis, back pain and problems or have had another spinal procedure before your hip replacement surgery.
Advanced knowledge of previous spine surgery or issues can help surgeons to decide if specialized X-rays of the hip and back are necessary, so they can talk to patients about the potential risk associated with their procedure.
The take-home point of the study shows that the hip and spine have a special relationship - and it's not just bones. The nerves of these two areas are also intertwined.
This relationship was also highlighted recently in a case study from AXIS Neuromonitoring, an intraoperative neuromonitoring company in Richardson, Texas.
"Intraoperative neuromonitoring is a way to monitor changes to the nerves and neural structures during surgery," said Dr. Faisal R. Jahangiri of AXIS.
During the study, the patient, a 65-year-old male with a history of lower back pain and right hip pain, was undergoing minimally invasive spine surgery for spinal stenosis in the lumbar area.
The study tracked changes to the patient's Somatosensory Evoked Potentials (SSEP) and Motor Evoked Potentials (TCeMEP). AXIS also monitored the patient through the use of electromyography (EMG). These readings were analyzed during the procedure by an AXIS technologist.
"Their job is to watch diagnostic equipment for changes in nerve response," Jahangiri said.
While performing the procedure, the surgeon placed a lateral dilator into the spine, which caused a lower-than-recommended EMG-elicited response in the area of the right adductor (thigh) and quadriceps muscles.
The technologist immediately informed the surgeon of the changes in the patient, and the dilator was then repositioned.
"As a result, the patient was able to avoid a life of muscle weakness, numbness, mobility issues or other complications caused by damage to the spinal nerves," Jahangiri said.
Source: Orthopedics This Week. 20% OF HIP REPLACEMENT PATIENTS MAY HAVE SPINAL DEFORMITY. 27 August 2019.
