Patients With a History of Lumbar Fusion Have a Greater Risk of Revision Arthroscopy and Conversion to Total Hip Arthroplasty After Primary Hip Arthroscopy

Abstract

PurposeTo characterize the risk of revision hip arthroscopy or conversion to total hip arthroplasty (THA) among patients with a history of lumbar fusion undergoing primary hip arthroscopy. MethodsWe used the Statewide Planning and Research Cooperative System, an administrative database including all ambulatory and inpatient surgery encounters in New York (NY), to identify all patients who underwent hip arthroscopy for FAI between 2010–2020. Patients with prior lumbar fusion were identified using CPT and ICD 9th/10th Revision coding definitions. Patients with and without prior fusion were matched in a 1:5 ratio according to age and comorbidity burden. The number of levels fused was defined in the following fashion: i) no fusion, ii) 1-2 levels, or iii) ≥3 levels. Patients were followed for two years to evaluate the rate of revision hip arthroscopy or conversion to THA. Multivariable logistic regression models were used to measure the association between number of levels fused and revision hip arthroscopy or conversion to THA. ResultsBetween 2010–2020, there were 23,277 patients that underwent primary hip arthroscopy in NY state. Of these, 348 (1.4%) had a prior lumbar fusion. After matching for age and comorbidities, the composite rate of revision hip arthroscopy or conversion to THA was higher in patients with prior lumbar fusion compared to patients without (16.5% vs. 8.5%; P < 0.001). This risk increased with the number of levels fused (1-2 levels: 15.1%; aOR, 1.8; 95% CI, 1.3–2.6; vs. ≥3 levels: 26.3%; aOR, 3.4; 95% CI, 1.7–7.0). ConclusionPatients with a history of lumbar fusion had significantly higher rates of revision hip arthroscopy and conversion to THA compared to patients without prior fusion. The risk of revision hip arthroscopy or conversion to THA was increased approximately 2-fold in patients with 1-2 levels fused and 3-fold in patients with 3 or more levels fused. Level of EvidenceLevel III, prognostic retrospective matched comparative case series.