A recent study published in the Journal of Bone & Joint Surgery reveals a significant overlap between adult spinal deformity (ASD) and severe osteoarthritis (OA) of the hip, shedding light on its impact on spinal alignment and physical function. The study by Diebo and colleagues highlights the challenges of concurrent hip and spine disease for surgeons.
ASD refers to various abnormalities in the curvature and alignment of the spine, which often become more prevalent as people age due to wear and tear. For patients who do not respond to non-surgical treatments, spinal realignment surgery may become a viable option. In this study, patients with ASD who underwent L1-pelvis, or longer fusions were included. Two independent reviewers graded hip OA using the Kellgren-Lawrence (KL) classification and classified it by severity into non-severe (KL grade 1 or 2) and severe (KL grade 3 or 4). Radiographic parameters and patient-reported outcome measures (PROMs) were compared among three patient groups: Hip-Spine (hip KL grade 3 or 4 bilaterally), Unilateral (UL)-Hip (hip KL grade 3 or 4 unilaterally), or spine (hip KL grade 1 or 2 bilaterally).
Out of 520 ASD patients analyzed for OA prevalence, 34% had severe bilateral hip OA, with 8.7% undergoing hip arthroplasty. A subset of 165 patients was examined: 68 hip-spine, 32 UL-ip, and 65 spine cases. Hip-spine patients were older with higher frailty indices. At one year, they showed worse sagittal vertebral axis (SVA), and physical component scores compared to UL-hip and spine groups. Patients with severe bilateral hip OA were typically older and exhibited higher frailty scores compared to those with unilateral OA or non-severe hip OA. While all groups showed similar lordosis correction postoperatively, those with severe hip OA demonstrated worse spinal alignment, as indicated by the SVA, before and after surgery.
Furthermore, patients with severe bilateral hip OA reported lower scores for physical functioning, persisting even after the correction of spinal deformity. Activities such as walking, traveling, and climbing stairs were notably affected, emphasizing the enduring impact of severe hip OA on functional outcomes.
The study underscores the necessity for careful perioperative evaluation and optimization of patients with concurrent hip and spine disease, given their complex medical condition and frailty. Diebo and colleagues stress the importance of further research to determine optimal strategies for enhancing outcomes in this challenging patient population.
In essence, the research sheds light on the intricate interplay between ASD and severe hip OA, highlighting the need for comprehensive management strategies to address the multifaceted needs of these patients. As the population continues to age, understanding and optimizing outcomes for individuals with concomitant hip and spine disease remain imperative in improving their quality of life and functional independence.
Reference
Diebo BG, Alsoof D, Balmaceno-Criss M, Daher M, Lafage R, Passias PG, et al. Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes. JBJS. 2021 Feb 26;10.2106/JBJS.23.00818.