Use of dual mobility cups in patients undergoing primary total hip arthroplasty with prior lumbar spine fusion.

Background: Patients undergoing primary total hip arthroplasty (THA) with prior lumbar spine fusion (LSF) are a high-risk group for instability with reported incidence of dislocation as high as 8.3% using fixed bearing femoral heads. Purpose of this study was to determine risk of post-operative instability in patients undergoing primary THA with a history of prior LSF using dual mobility acetabular cups.

Methods: This was a multicenter retrospective study with 93 patients undergoing primary THA using a dual mobility cup with a prior history of instrumented LSF. There were 56 females and 47 males with an average age of 66 years (46-87) and average BMI of 30 with mean follow-up of 2.7 years (range 12-124 months). Surgical approach included posterior (63), direct lateral (15), anterior (11), and direct superior (4). Forty-four percent had one level lumbar fusion, 29% with two levels, and 15% with three or more levels fused. The primary outcome investigated was instability.

Results: There were no cases of instability or prosthetic joint infection in this group of patients with prior lumbar spine fusion undergoing primary THA using a dual mobility cup. There was one intra-operative periprosthetic femur fracture and one case of aseptic acetabular cup loosening.

Conclusion: Patients undergoing THA with prior LSF are at increased risk for instability due to loss of normal spinopelvic relationship. The use of dual mobility cups in patients with prior LSF undergoing primary THA appears promising with no cases of instability in this high-risk group of patients.