Spine - 2026-03-24 - Journal Article
Impact of Operative Order on Postoperative Outcomes in Patients Undergoing Lumbar Fusion and Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.
Al-Saidi N, Al-Saidi N, Nguyen R, Dominari A, Reilly A, Mohammed D, Bydon M
Topics
Key Takeaway
In 161,326 patients with concomitant lumbar fusion and THA, operative order (SAHA vs. HASA) produced no significant difference in hip dislocation, mechanical loosening, periprosthetic fracture, DVT, infection, or revision rates (3.6% vs. 2.6%, P=0.5).
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Summary
This systematic review and meta-analysis asked whether performing lumbar fusion before THA (SAHA) versus THA before fusion (HASA) affects postoperative complications and revision rates. Random-effects meta-analysis of 22 studies (n=161,326) found SAHA was performed in 88.4% of cases. No statistically significant differences were identified between groups for any complication category or revision rate (SAHA 3.6% vs. HASA 2.6%, P=0.5).
Key Limitation
The 88.4% SAHA prevalence across included studies introduces profound selection bias, making the HASA group a non-representative minority whose indications and baseline characteristics likely differ systematically from the SAHA group.
Original Abstract
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To assess how operative order affects clinical outcomes and complications in patients with concomitant lumbar spinal and hip pathologies.
SUMMARY OF BACKGROUND DATA
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.