Study Design Retrospective cohort study. Objective To evaluate whether undergoing total hip arthroplasty (THA) influences the risk of subsequent lumbar intervention in patients with lumbar degenerative disease (LDD) and hip osteoarthritis (HOA), and to identify patient-specific risk factors and procedural characteristics associated with post-THA lumbar intervention. Methods Utilizing the PearlDiver Mariner Database (2010-2023), 1 194 269 patients with LDD and HOA were included, 16.3% of whom underwent THA. Patients with prior lumbar surgeries, trauma, infection and malignancy were excluded. Multivariable logistic regression adjusted for demographics, comorbidities, and scoliosis was performed. Subgroup analyses assessed procedural characteristics, lumbar pathologies, and comorbidities within the THA cohort. Results THA was associated with reduced odds of lumbar decompression (OR 0.42, 95% CI 0.41-0.44) and fusion (OR 0.42, 95% CI 0.40-0.44, both P < 0.001). Predictors of lumbar surgery after THA included preoperative opioid use, obesity, fibromyalgia, depression, diabetes, scoliosis, spondylolisthesis, myelopathy, radiculopathy, stenosis, and spondylolysis. Unilateral THA was associated with significantly higher odds of subsequent lumbar intervention compared with the reference group, whereas bilateral THA was associated with significantly lower odds of subsequent lumbar intervention compared with the same reference group. Risk was highest in patients aged 60-69 years but decreased in those over 69. THA also delayed the average time to lumbar intervention. Conclusion THA, particularly bilateral procedures, was protective against future lumbar surgery in patients with HOA and LDD. Unilateral THA was less protective, potentially reflecting spinopelvic imbalance. These findings refine understanding of hip-spine syndrome and support prioritizing timely hip arthroplasty in high-risk patients with severe HOA.
Issani et al. (2025) studied this question.