Impact of Operative Order on Postoperative Outcomes in Patients Undergoing Lumbar Fusion and Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Systematic review and meta-analysis. To assess how operative order affects clinical outcomes and complications in patients with concomitant lumbar spinal and hip pathologies. Concomitant lumbar spinal and hip pathologies are becoming increasingly prevalent in the growing population. Determining the optimal operative order for surgical treatment remains challenging, particularly when comparing spine arthrodesis followed by hip arthroplasty (SAHA) with hip arthroplasty followed by spine arthrodesis (HASA). Prior studies report conflicting results regarding outcomes and complications. A comprehensive literature search was performed to identify studies reporting on postoperative outcomes and complications in patients with concomitant lumbar spinal and hip pathologies. Random-effects model meta-analysis of pooled outcomes was performed comparing operative order groups (SAHA and HASA), with postoperative complications and revisions being our primary endpoints. A total of 22 studies, yielding 161,326 patients who received surgical treatment for concomitant lumbar spinal and hip pathologies, were included. The majority of patients underwent SAHA (pooled estimate: 88.4%, 95% CI: 76.9-96.3%, P =0.01). Females comprised 56.1% (95% CI: 49.2-62.8%) of the study population. The mean age was 70.6±6.4 years, and the mean follow-up duration was 2.6±2.1 years. The mean number of treated levels was 2.1±1.4. No significant differences were noted between the SAHA and HASA groups with respect to complications, including hip dislocation ( P =0.7), mechanical loosening ( P =0.8), periprosthetic fractures ( P =0.7), deep venous thrombosis (DVT) ( P =0.8), and infection ( P =0.9). Revisions were required in 3.6% of patients in the SAHA group (95% CI: 2.5-4.9%) and 2.6% of patients in the HASA group (95% CI: 0.5-6.2%, P =0.5). Among patients surgically treated for concomitant lumbar spinal and hip pathologies, SAHA was significantly more commonly performed than HASA. Our analysis shows that postoperative complications and revisions did not significantly differ depending on operative order.