Selection of spinal surgery and hip replacement sequence in patients with both degenerative scoliosis and hip disease

Abstract

Objective To discuss how the sequence of spinal surgery and hip replacement is determined for patients with both degenerative scoliosis and hip disease. Methods Twenty-six patients treated for both degenerative scoliosis and hip disease from June 2012 to June 2015 were retrospectively studied. Eleven patients underwent hip replacement followed by lumbar surgery (Group A), and 15 patients underwent lumbar surgery followed by hip replacement (Group B). The average follow-up duration was 1.5 years. Related indicators were assessed preoperatively and postoperatively. Results The parameters showing significant differences between Groups A and B after surgery were acetabular anteversion, the Oswestry functional disability score, and the Harris hip score. Postoperatively, five patients in Group A had unequal shoulder heights and inclination of the trunk to one side. After lumbar surgery and before total hip arthroplasty in Group B, eight patients could not walk, and the limitation was more severe than that preoperatively. Conclusion Spinal surgery may be performed first to resolve lumbar nerve symptoms and restore sagittal balance of the spine; hip replacement may then be performed to simplify hip replacement difficulties and resolve the imbalance after spinal surgery. Severely limited range of motion exists after lumbar surgery and before total hip arthroplasty.