A study has found that one-third of patients who undergo adult spinal deformity (ASD) surgery also suffer from severe hip osteoarthritis (OA), which can lead to poor spinal alignment and physical function.
The findings were published in the Journal of Bone and Joint Surgery.
According to new research from Alan H. Daniels, MD, and Bassel Diebo, MD, of Brown University, and colleagues from 20 North American spine surgery centers, even after surgical treatment of ASD , these differences still exist. “Concomitant hip and spine disorders are common but remain challenging for joint replacement and spine surgeons,” the researchers wrote.
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Adult spinal deformities refer to various abnormalities in the curvature and alignment of the spine. Because some of these malformations develop over time, they may become more frequent in an aging population. For people with ASD who do not improve with non-surgical treatments, spinal corrective surgery may be necessary.
Previous studies have reported a high incidence of hip OA concomitant with ASD. However, little is known about how OA affects characteristics and surgical outcomes in patients with ASD, including spinal alignment and patient-reported outcomes such as physical function and disability.
PhD. Daniels and Diebo and colleagues analyzed the incidence and outcomes of hip OA in 520 older adults who underwent ASD surgery at one of 13 centers in the United States and Canada. About two-thirds of the patients are women, and the average age is 59 years. Consistent with previous studies, 34% of patients were classified as having severe OA involving both hips.
Researchers compared characteristics of ASD patients with and without severe hip osteoarthritis, including key patient-reported outcome measures. The characteristics and outcomes of 165 patients were also compared at postoperative follow-up: 68 patients had severe bilateral hip OA, 32 patients had severe OA in only one hip, and 65 patients had severe OA in either hip. None of the patients had severe OA.
Based on preoperative analysis, patients with severe bilateral hip OA were older (mean age, 68 years) than patients with unilateral (66 years) and/or non-severe hip OA (60 years). People with severe hip osteoarthritis also scored higher on standard frailty assessments.
At one-year follow-up, lordosis correction was similar in all three groups. However, patients with severe hip OA have poor spinal alignment based on a radiographic measurement called the sagittal vertebral axis (SVA). The difference in SVA was significant both preoperatively and at follow-up.
Some patient-reported outcomes also found worse outcomes in patients with severe bilateral hip osteoarthritis, who had lower physical function scores preoperatively and at follow-up. Although global disability scores did not differ significantly between groups, severe hip osteoarthritis was associated with persistent reductions in activities such as walking, traveling, and climbing stairs. Frailty contributes to differences in functional outcomes.
The study is one of the first to “investigate alignment and functional outcomes in patients with hip osteoarthritis undergoing surgery for severe autism spectrum disorder,” the researchers wrote. The findings indicate that people with autism spectrum disorder who have severe osteoarthritis in both hips are older, more frail, and have worse physical function and disability scores, even after accounting for spinal deformity correction.
“[G]”Given the complexity of concomitant hip and spine disease and the relative frailty of these patients, they require careful evaluation and optimization in the perioperative period,” Dr. Daniels and co-authors concluded. “Further research is needed,” they added. research to elucidate how to optimize outcomes in this complex patient population. “