Total Hip Arthroplasty in Patients with Vertebral Compression Fracture is Associated with Poor Clinical Outcomes - Retrospective Analysis on 453 Cases

Overview

Journal J Exp Orthop

Publisher Wiley

Specialty Orthopedics

Date 2023 May 24

PMID 37222873

Authors

Chin-Hsi Chen

Yaichiro Okuzu

Koji Goto

Yutaka Kuroda

Toshiyuki Kawai

Shuichi Matsuda

Affiliations

Soon will be listed here.

Abstract

Purpose: Total hip arthroplasty (THA) is increasingly performed in older adults, and the prevalence of vertebral compression fracture (VCF) increases with age. We aimed to investigate the clinical outcomes of THA in patients with VCF.

Methods: We reviewed the records of 453 patients who underwent THA at our institution between 2015 and 2021. We classified patients into those with and without VCF. VCF was identified using preoperative upright whole-spine radiographs. Spinal parameters, preoperative and 1-year postoperative clinical outcomes of the Harris hip score (HHS), Oxford hip score (OHS), and visual analog scale (VAS) for low back pain (LBP) were assessed. Furthermore, propensity score-matched cohorts for age, sex, body mass index, and spinal parameters were created, and the clinical outcomes were compared between the two groups.

Results: Among the 453 patients, 51 (11.3%) with VCF and 402 without VCF were identified. Before matching, patients with VCF were older (p < 0.01), had sagittal spinal imbalance (p < 0.01), and had worse clinical outcomes pre- and postoperatively. After matching 47 patients in both groups, patients with VCF had worse HHS (p < 0.05), especially regarding support and distance walked, and worse VAS scores for LBP (p < 0.05) pre- and postoperatively. However, the improvements in scores were not significantly different between the groups.

Conclusions: HHS, especially regarding support and distance walked, and VAS scores for LBP were poorer in patients with VCF preoperatively and 1-year postoperatively. Our findings suggest that hip surgeons should evaluate not only spinal alignment but also the presence of VCF before performing THA.

Level Of Evidence: Level III, Retrospective cohort study.

References

Schousboe J . Epidemiology of Vertebral Fractures. J Clin Densitom. 2015; 19(1):8-22. DOI: 10.1016/j.jocd.2015.08.004. View

Chen L, Woo J, Assantachai P, Auyeung T, Chou M, Iijima K . Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020; 21(3):300-307.e2. DOI: 10.1016/j.jamda.2019.12.012. View

Burger H, van Daele P, Grashuis K, Hofman A, Grobbee D, SCHUTTE H . Vertebral deformities and functional impairment in men and women. J Bone Miner Res. 1997; 12(1):152-7. DOI: 10.1359/jbmr.1997.12.1.152. View

Kremers H, Larson D, Crowson C, Kremers W, Washington R, Steiner C . Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am. 2015; 97(17):1386-97. PMC: 4551172. DOI: 10.2106/JBJS.N.01141. View

Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M . Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005; 87(7):1487-97. DOI: 10.2106/JBJS.D.02441. View

Cruz-Jentoft A, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T . Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2018; 48(1):16-31. PMC: 6322506. DOI: 10.1093/ageing/afy169. View

Johansson L, Sundh D, Nilsson M, Mellstrom D, Lorentzon M . Vertebral fractures and their association with health-related quality of life, back pain and physical function in older women. Osteoporos Int. 2017; 29(1):89-99. PMC: 5758688. DOI: 10.1007/s00198-017-4296-5. View

Arima K, Abe Y, Nishimura T, Okabe T, Tomita Y, Mizukami S . Association of vertebral compression fractures with physical performance measures among community-dwelling Japanese women aged 40 years and older. BMC Musculoskelet Disord. 2017; 18(1):176. PMC: 5410022. DOI: 10.1186/s12891-017-1531-3. View

Kurtz S, Ong K, Lau E, Mowat F, Halpern M . Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780-5. DOI: 10.2106/JBJS.F.00222. View

10.

Pluijm S, Tromp A, Smit J, Deeg D, Lips P . Consequences of vertebral deformities in older men and women. J Bone Miner Res. 2000; 15(8):1564-72. DOI: 10.1359/jbmr.2000.15.8.1564. View

11.

Toro G, Bothorel H, Saffarini M, Jacquot L, Chouteau J, Rollier J . Uncemented total hip arthroplasty in octogenarian and nonagenarian patients. Eur J Orthop Surg Traumatol. 2018; 29(1):103-110. DOI: 10.1007/s00590-018-2242-7. View

12.

Jinbayashi H, Aoyagi K, Ross P, Ito M, Shindo H, Takemoto T . Prevalence of vertebral deformity and its associations with physical impairment among Japanese women: The Hizen-Oshima Study. Osteoporos Int. 2002; 13(9):723-30. DOI: 10.1007/s001980200099. View

13.

Sloan M, Premkumar A, Sheth N . Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018; 100(17):1455-1460. DOI: 10.2106/JBJS.17.01617. View

14.

Cawthon P, Blackwell T, Marshall L, Fink H, Kado D, Ensrud K . Physical performance and radiographic and clinical vertebral fractures in older men. J Bone Miner Res. 2014; 29(9):2101-8. PMC: 4335673. DOI: 10.1002/jbmr.2239. View

15.

Genant H, Wu C, van Kuijk C, Nevitt M . Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993; 8(9):1137-48. DOI: 10.1002/jbmr.5650080915. View

16.

Takahashi K, Kubo A, Ishimura K, Fukui T, Tamura T . Correlation among sarcopenia, malnutrition and activities of daily living in patients with vertebral compression fractures: a comparison based on admission and discharge parameters evaluating these conditions. J Phys Ther Sci. 2018; 30(12):1401-1407. PMC: 6279703. DOI: 10.1589/jpts.30.1401. View

17.

Chau L, Hu Z, Ko K, Man G, Yeung K, Law Y . Global sagittal alignment of the spine, pelvis, lower limb after vertebral compression fracture and its effect on quality of life. BMC Musculoskelet Disord. 2021; 22(1):476. PMC: 8146251. DOI: 10.1186/s12891-021-04311-8. View

18.

Ueoka K, Kabata T, Kajino Y, Inoue D, Ohmori T, Ueno T . The prevalence and impact of sarcopenia in females undergoing total hip arthroplasty: A prospective study. Mod Rheumatol. 2021; 32(1):193-198. DOI: 10.1080/14397595.2021.1899603. View

19.

Crowe J, Mani V, Ranawat C . Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979; 61(1):15-23. View

20.

Ochi H, Homma Y, Baba T, Nojiri H, Matsumoto M, Kaneko K . Sagittal spinopelvic alignment predicts hip function after total hip arthroplasty. Gait Posture. 2016; 52:293-300. DOI: 10.1016/j.gaitpost.2016.12.010. View