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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015



Functional deficits persist in a significant percentage of total hip arthroplasties (THA), leading to patient dissatisfaction. Spinal stenosis is a leading cause of chronic disability and lower extremity weakness. Although previous studies have evaluated the potential benefit of THA on back pain, none have reported the effects of spine disability on functional outcomes and patient satisfaction with THA.


244 primary THAs (233 patients) with minimum 2-year follow-up rated their satisfaction, return to activity, and standard hip outcomes using the Oxford Hip Score (OHS). History of lumbar spine pain, lumbar surgery, and daily activity limitations was documented and an Oswestry Disability Index (ODI) score was calculated.


151 of 244 (62%) patients reported a history of back problems: 35 patients (14%) – history of lumbar surgery, 91 (37%) – daily low back pain, and 97 (40%) – back pain that limited activity. Patients with a history of back problems had lower OHS scores than those without, p=0.0001. Pain relief was reported by 93% versus resumption of activities in 82% of THA patients, p=0.025. Increasing spine disability, as determined by ODI, correlated with poor OHS, p<0.0001. Spine disability (ODI) was directly associated with patient dissatisfaction for pain relief (R=0.41, p<0.0001), return to activity (R=0.34, p<0.0001), and overall surgical results (ODI, R=0.38, p<0.0001) at 2 years after THA. Patient age, gender, and BMI were not associated with poor THA outcomes.


The majority of THA patients have a history of lumbar spine problems. The Oswestry Spine Disability Index, which is the primary outcome measure of spinal disorders, correlated strongly with poor THA outcomes. Moderate and severe lumbar spine disability directly correlated with worse Oxford Hip Scores. Spine disability was directly associated with THA dissatisfaction.