DOI: 10.1097/brs.0000000000005830 ISSN: 0362-2436

Impact of Concomitant Hip Osteoarthritis on Pelvic Decompensation, Spinopelvic Alignment, and Surgical Outcomes in Degenerative Lumbar Scoliosis

Xing Chen, Shangye Li, Rongkun Xu, Wenyang Fu, Yuchen Zhang, Suomao Yuan, Lianlei Wang, Honglin Teng, Xinyu Liu
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Study Design.

Retrospective study

Summary of Background Data.

A considerable proportion of patients with degenerative lumbar scoliosis (DLS) have concomitant hip osteoarthritis (OA). However, the effect of hip OA on DLS patients remains unclarified.

Purpose.

To investigate the impact of concomitant hip OA on patient-reported outcome measures (PROMs) and global spinopelvic alignment in DLS.

Methods.

Patients were divided into severe and low OA groups based on the Kellgren-Lawrence (KL) classification, with grades 0 to 2 classified as low OA and grades 3 or 4 classified as severe OA. Radiographic parameters and PROMs including the Visual Analog Scale (VAS), Scoliosis Research Society-22 (SRS-22), and Oswestry Disability Index (ODI) were compared among 3 groups: Bilateral severe, Unilateral severe, or Bilateral low. Multivariable regression analysis was performed to assess the effect of hip OA on pelvic decompensation and PROMs.

Results.

A total of 134 patients were enrolled: 61 Bilateral severe, 25 Unilateral severe, and 48 Bilateral low. Bilateral severe hip OA was independently associated with pelvic decompensation (OR 1.37, 95% CI: 1.09-1.54, P =.016). At 2-year postoperatively, severe OA patients exhibited worse global sagittal malalignment and inferior clinical outcomes. Multivariate analysis showed that bilateral severe OA was significantly associated with worse baseline ODI (B=0.352, 95% CI: 0.082 to 0.622) and SRS-function (B=−0.405, 95% CI: −0.749 to −0.062), and 2-year VAS-back pain (B=0.223, 95% CI: 0.021 to 0.425), VAS-leg pain (B=0.365, 95% CI: 0.057 to 0.673), SRS-pain (B=−0.326,95% CI: −0.619 to −0.020 ), SRS-function (B=−0.337, 95% CI: −0.734 to −0.090) and ODI (B=0.323, 95% CI: 0.039 to 0.607).

Conclusions.

Severe hip OA was associated with pelvic decompensation and reduced hip extension. Patients with severe hip OA had worse baseline sagittal malalignment and inferior PROMs that persisted 2 year following surgery. These findings underscore the importance of evaluating hip OA during preoperative planning for DLS.

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