JAAOS - 2026-09-15 - Journal Article
Impact of Prior Joint Arthroplasty on Reoperation Rate Following Lumbar Spinal Fusion.
Daher M, Zalaket J, Maalouf Y, Youssef B, Samaha M, Liu J, Sebaaly A, El-Othmani MM, Diebo BG, Daniels AH
Topics
Key Takeaway
Prior THA before lumbar spinal fusion carries a 32.5% spinal fusion revision rate at 2 years, compared to 10.6% in patients with no prior arthroplasty.
Summary Depth
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Summary
This study used the PearlDiver Mariner Database to compare 90-day readmission, ED visits, and spinal fusion revision rates after elective lumbar spinal fusion for stenosis across four cohorts: no prior TJA, prior TKA only, prior THA only, and prior both TKA and THA, matched 1:1:1:1 for age, sex, obesity, and CCI. The no-TJA group had the lowest 90-day readmission (7.6%) and ED visit rates (18.9%), while the spine-TJA group had the highest ED visit rate (31.1%). The spine-THA group had the highest revision rates at 1 year (15.6%) and 2 years (32.5%), compared to 5.6% and 10.6% in the no-TJA group.
Key Limitation
Claims-based data preclude determination of whether elevated revision rates reflect true surgical failure (pseudarthrosis, adjacent segment disease) versus coding artifacts or unrelated reoperations, limiting mechanistic interpretation.
Original Abstract
OBJECTIVE
This study aims to fill this gap by comparing the surgical and medical complications after elective lumbar fusion outcomes between patients with prior total knee arthroplasty (TKA), total hip arthroplasty (THA), both, or none.
BACKGROUND
The prevalence of patients requiring lumbar spinal fusion (LSF) with prior total joint arthroplasty (TJA, TKA, THA) is increasing. However, the impact of both prior THA and TKA, or either TKA/THA on the outcomes of LSF is still incompletely understood.
METHODS
This is a retrospective review of the PearlDiver Mariner Database. Patients undergoing elective LSF for spinal stenosis between 2010 and 2020 were identified and grouped based on prior arthroplasty history into four cohorts: no-TJA, spine-TKA, spine-THA, and spine-TJA (both TKA and THA). The four groups were matched in a 1:1:1 ratio based on age, sex, obesity, and Charlson Comorbidity Index.
RESULTS
Patients in the no-TJA group had the lowest readmission (7.6%; P < 0.001) and emergency department (ED) visits rates (18.9%; P < 0.001) at 90 days postoperatively. Patients in the spine-TJA group had the highest ED visits rate (31.1%, P < 0.001). Furthermore, the group with no previous TKA/THA had the lowest rate of revisions at 1 year (5.6%, P < 0.001) and 2 years postoperatively (10.6%, P < 0.001), whereas the spine-THA group had the highest rate at both 1 (15.6%, P < 0.001) and 2 years (32.5%, P < 0.001).
CONCLUSION
This study highlights the considerable challenges and complications faced by patients with prior hip and knee replacement undergoing LSF. Patients with prior TKA and THA had higher rates of ED visits at 90 days postoperatively and higher revision spinal fusion rates. Patients undergoing LSF with prior THA suffered a 30% revision spinal fusion rate within 2 years.
STUDY DESIGN
Retrospective analysis.