Pub Date : 2026-03-13DOI: 10.1097/corr.0000000000003897
Siyuan Qu,Jiaxing Ding,Jiajun Song,Huajun Jiang
{"title":"Letter to the Editor: High Risk of Venous Thromboembolism With Aspirin Prophylaxis After THA for High-riding Developmental Dysplasia of the Hip: A Retrospective, Comparative Study.","authors":"Siyuan Qu,Jiaxing Ding,Jiajun Song,Huajun Jiang","doi":"10.1097/corr.0000000000003897","DOIUrl":"https://doi.org/10.1097/corr.0000000000003897","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"73 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-12DOI: 10.1097/corr.0000000000003870
Seth S Leopold
{"title":"Editor's Spotlight/Take 5: Is the Completion of a Research Gap Year or Summer Research Program Associated With Increased Odds of Matching Into Orthopaedic Residency? A Systematic Review.","authors":"Seth S Leopold","doi":"10.1097/corr.0000000000003870","DOIUrl":"https://doi.org/10.1097/corr.0000000000003870","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"52 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-10DOI: 10.1097/corr.0000000000003899
Hongsheng Wang,Jiakang Shen,Dongqing Zuo,Kaiyuan Liu,Wei Sun
BACKGROUNDFunctional reconstruction after resection of malignant pelvic tumors involving zones I + II ± IV remains a major challenge in orthopaedic oncology. Conventional hip transposition can reduce prosthesis-related complications, but it is often associated with limb shortening and femoral head malrotation. We propose a modified hip transposition technique-femoral lengthening and retroversion hip transposition with a customized three-dimensionally (3D) printed femoral prosthesis-to address deficiencies in limb length, femoral head positioning, and fixation stability, and we evaluate its effectiveness in reducing complications and improving functional outcomes.QUESTIONS/PURPOSESIn the context of a small, initial patient series, we asked: (1) What was the postoperative functional outcome, as assessed by Musculoskeletal Tumor Society 1993 (MSTS-93) score, after reconstruction using this technique? (2) What were the frequency and nature of complications associated with the method? (3) How well was limb length restored at a minimum follow-up of 3 years?METHODSBetween January 2019 and December 2021, a total of 49 patients underwent resection and reconstruction for pelvic zone I + II ± IV tumors. Of these, 18% (9) received the modified hip transposition with a customized 3D-printed femoral lengthening and retroversion prosthesis. This approach was selected for patients in whom sufficient proximal femur was preserved to allow controlled osteotomy and femoral lengthening, who were unsuitable for standard hemipelvic endoprosthetic reconstruction because of extensive bone or soft tissue defects, who had histologically confirmed primary malignant or aggressive pelvic tumors, and who were expected to have long-term survival without distant metastasis. The remaining 82% (40) of patients treated during the same period underwent alternative reconstruction strategies, including hemipelvic endoprosthetic reconstruction, external hemipelvectomy, or conventional hip transposition. No patients were lost to follow-up. Three patients died of pulmonary metastases during follow-up and were included in the analysis with their actual follow-up durations. The six surviving patients had a median (range) follow-up time of 43 months (37 to 50). Among the nine patients included in this study, three were male and six were female, with a median (range) age of 55 years (19 to 73). At final follow-up, functional outcomes were assessed using the MSTS-93 score, complications were recorded and categorized, and limb-length discrepancy (LLD) was measured radiographically.RESULTSThe six surviving patients achieved a median (range) MSTS-93 score of 24 (21 to 27) with minimal or no pain. Four patients used a cane for ambulation, and two walked independently. Two patients experienced delayed wound healing, which resolved with dressing changes; no prosthetic infections or mechanical failures occurred. Median (range) postoperative LLD was 1.0 cm (0.5 to 2.0) after intraoperative prosthesis
{"title":"Is Functional Reconstruction Feasible With Modified Hip Transposition Using a Customized 3D-printed Femoral Prosthesis After Pelvic Tumor Resection? A Preliminary Study.","authors":"Hongsheng Wang,Jiakang Shen,Dongqing Zuo,Kaiyuan Liu,Wei Sun","doi":"10.1097/corr.0000000000003899","DOIUrl":"https://doi.org/10.1097/corr.0000000000003899","url":null,"abstract":"BACKGROUNDFunctional reconstruction after resection of malignant pelvic tumors involving zones I + II ± IV remains a major challenge in orthopaedic oncology. Conventional hip transposition can reduce prosthesis-related complications, but it is often associated with limb shortening and femoral head malrotation. We propose a modified hip transposition technique-femoral lengthening and retroversion hip transposition with a customized three-dimensionally (3D) printed femoral prosthesis-to address deficiencies in limb length, femoral head positioning, and fixation stability, and we evaluate its effectiveness in reducing complications and improving functional outcomes.QUESTIONS/PURPOSESIn the context of a small, initial patient series, we asked: (1) What was the postoperative functional outcome, as assessed by Musculoskeletal Tumor Society 1993 (MSTS-93) score, after reconstruction using this technique? (2) What were the frequency and nature of complications associated with the method? (3) How well was limb length restored at a minimum follow-up of 3 years?METHODSBetween January 2019 and December 2021, a total of 49 patients underwent resection and reconstruction for pelvic zone I + II ± IV tumors. Of these, 18% (9) received the modified hip transposition with a customized 3D-printed femoral lengthening and retroversion prosthesis. This approach was selected for patients in whom sufficient proximal femur was preserved to allow controlled osteotomy and femoral lengthening, who were unsuitable for standard hemipelvic endoprosthetic reconstruction because of extensive bone or soft tissue defects, who had histologically confirmed primary malignant or aggressive pelvic tumors, and who were expected to have long-term survival without distant metastasis. The remaining 82% (40) of patients treated during the same period underwent alternative reconstruction strategies, including hemipelvic endoprosthetic reconstruction, external hemipelvectomy, or conventional hip transposition. No patients were lost to follow-up. Three patients died of pulmonary metastases during follow-up and were included in the analysis with their actual follow-up durations. The six surviving patients had a median (range) follow-up time of 43 months (37 to 50). Among the nine patients included in this study, three were male and six were female, with a median (range) age of 55 years (19 to 73). At final follow-up, functional outcomes were assessed using the MSTS-93 score, complications were recorded and categorized, and limb-length discrepancy (LLD) was measured radiographically.RESULTSThe six surviving patients achieved a median (range) MSTS-93 score of 24 (21 to 27) with minimal or no pain. Four patients used a cane for ambulation, and two walked independently. Two patients experienced delayed wound healing, which resolved with dressing changes; no prosthetic infections or mechanical failures occurred. Median (range) postoperative LLD was 1.0 cm (0.5 to 2.0) after intraoperative prosthesis","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"14 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-10DOI: 10.1097/CORR.0000000000003894
Philippe-Alexandre Faure
{"title":"CORR Insights®: Severe Damage to the Ligamentous-Fossa-Foveolar Complex Is Common in Patients Undergoing Surgical Hip Dislocation for Femoroacetabular Impingement.","authors":"Philippe-Alexandre Faure","doi":"10.1097/CORR.0000000000003894","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003894","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-10DOI: 10.1097/corr.0000000000003898
Amanda Mener
{"title":"CORR Insights®: Women Are Unequally Represented Among Clinical Trial Leadership by Orthopaedic Subspecialty.","authors":"Amanda Mener","doi":"10.1097/corr.0000000000003898","DOIUrl":"https://doi.org/10.1097/corr.0000000000003898","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"1 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-06DOI: 10.1097/corr.0000000000003891
Dae-Woong Ham,Hyun Kang,Yoo-Sun Won,Jeuk Lee,Sang-Min Park,Youngbae B Kim,Dong-Gune Chang,Kwang-Sup Song
BACKGROUNDPostoperative pain management after lumbar spine surgery often involves modest to high doses of opioids, which can contribute to the risk of dependence. Epidural analgesia has emerged as a promising opioid-sparing alternative, but its efficacy compared with conventional opioid-based intravenous patient-controlled analgesia (IV-PCA) in a randomized trial has not been established in these patients.QUESTIONS/PURPOSESWe asked whether an opioid-sparing protocol, compared with conventional opioid-based IV-PCA, (1) provides superior pain control, (2) reduces opioid consumption, and (3) lowers the frequency of opioid-related adverse events.METHODSIn this multicenter, randomized, double-blind, parallel-group trial, we enrolled 98 patients undergoing single-level lumbar fusion or decompression. Eligible participants were adults age 20 to 80 years diagnosed with lumbar spinal stenosis or spondylolisthesis. Exclusion criteria included history of prior lumbar surgery, coagulation disorders, or opioid dependence. Patients were randomized to either the epidural opioid-free IV-PCA group (intraoperative single-shot epidural ropivacaine injection with opioid-free IV-PCA; epidural group) or the conventional opioid-based IV-PCA group (fentanyl-based IV-PCA; control group). In the epidural opioid-free group, fentanyl was administered solely as a rescue analgesic for breakthrough pain. All patients and outcome assessors were blinded to group allocation. In the fusion arm, 25 patients were randomized to the epidural group and 25 to the control group; data from all randomized patients (n = 25 in each group) were fully analyzed. In the decompression arm, 24 were randomized to the epidural group and 24 to the control group; data from all randomized patients (n = 24 in each group) were fully analyzed. Three patients (one in the fusion arm and two in the decompression arm) discontinued the intervention because of severe postoperative nausea and vomiting but were included in the final analysis based on the intention-to-treat principle, preventing differential loss to follow-up bias. There were no important differences between treatment and control groups in terms of baseline demographic or clinical data in either study arm. The minimum clinically important difference (MCID) for the numeric rating scale (NRS) pain score was defined as 2 points. The sample size was calculated to detect a 15% reduction in NRS scores (0.9 points), ensuring sensitivity to differences smaller than the MCID of 2 points. Secondary outcomes included total fentanyl consumption, rescue analgesic demand, and opioid-related adverse events.RESULTSThere were no clinically important differences between the epidural and control groups in either the decompression or the fusion arms of the study in terms of NRS pain scores at any time point (the largest difference was seen at 24 hours in the fusion group, but it was not clinically important: mean ± SD 2.7 ± 1.5 versus 4.4 ± 1.5 points of 10 total, me
背景：腰椎手术后的疼痛管理通常涉及适度到高剂量的阿片类药物，这可能会增加依赖性的风险。硬膜外镇痛已成为一种很有前景的阿片类药物节约替代方法，但在一项随机试验中，其与传统的基于阿片类药物的静脉自控镇痛（IV-PCA）相比的疗效尚未在这些患者中得到证实。问题/目的我们询问与传统的基于阿片类药物的IV-PCA相比，阿片类药物节约方案是否(1)提供了更好的疼痛控制，(2)减少了阿片类药物的消耗，(3)降低了阿片类药物相关不良事件的频率。方法在这项多中心、随机、双盲、平行组试验中，我们招募了98例接受单节段腰椎融合或减压的患者。符合条件的参与者是年龄在20到80岁之间，诊断为腰椎管狭窄或腰椎滑脱的成年人。排除标准包括腰椎手术史、凝血功能障碍或阿片类药物依赖。患者被随机分为硬膜外无阿片类药物IV-PCA组（术中单次硬膜外注射罗哌卡因，无阿片类药物IV-PCA；硬膜外组）或传统的基于阿片类药物的IV-PCA组（芬太尼为基础的IV-PCA；对照组）。在硬膜外无阿片类药物组，芬太尼被单独给予作为突破性疼痛的救援镇痛药。所有患者和结果评估者对组分配均采用盲法。在融合臂，25例患者随机分为硬膜外组和对照组；对所有随机患者（每组25例）的数据进行充分分析。减压组随机选择硬膜外组24例，对照组24例；对所有随机患者（每组24例）的数据进行充分分析。3例患者（融合臂1例，减压臂2例）因术后严重恶心和呕吐而停止干预，但根据意向治疗原则纳入最终分析，以防止因随访偏倚而导致的差异损失。在两组研究中，治疗组和对照组在基线人口统计学或临床数据方面没有显著差异。数值评定量表（NRS）疼痛评分的最小临床重要差异（MCID）定义为2分。计算样本量以检测NRS分数减少15%（0.9分），确保对小于2分的MCID差异的敏感性。次要结局包括芬太尼总消耗量、救援镇痛药需求和阿片类药物相关不良事件。结果硬膜外组和对照组在研究的减压组和融合组在任何时间点的NRS疼痛评分没有重要的临床意义(融合组在24小时的差异最大，但没有重要的临床意义：平均±SD 2.7±1.5比4.4±1.5分，平均差-1.8分[95%可信区间(CI) -2.6至-0.9]；P = 0.04)。然而，尽管在疼痛控制方面没有重要差异，硬膜外组的芬太尼消耗量低于融合组（122±140比1467±481µg，平均差-1345µg [95% CI -1550至-1140]，p < 0.001）和减压组（41±51比1046±451µg，平均差-1005µg [95% CI -1196至-813]，p < 0.001）。在该研究的融合组中，硬膜外组术后尿潴留较少见（4%[1 / 25]对32%[8 / 25]，相对风险0.13 [95% CI 0.02 ~ 0.93]; p = 0.02）；在研究的减压组中，硬膜外组和对照组之间的并发症没有差异。结论单节段腰椎手术后单次硬膜外注射罗哌卡因可有效控制疼痛，减少阿片类药物消耗，降低尿潴留风险。该方案是一种可行和有效的阿片类药物节约策略。证据水平：I级，治疗性研究。
{"title":"Single Epidural Analgesia With Opioid-free IV-PCA Reduces Opioid Consumption in Lumbar Spine Surgery: A Randomized, Multicenter Trial.","authors":"Dae-Woong Ham,Hyun Kang,Yoo-Sun Won,Jeuk Lee,Sang-Min Park,Youngbae B Kim,Dong-Gune Chang,Kwang-Sup Song","doi":"10.1097/corr.0000000000003891","DOIUrl":"https://doi.org/10.1097/corr.0000000000003891","url":null,"abstract":"BACKGROUNDPostoperative pain management after lumbar spine surgery often involves modest to high doses of opioids, which can contribute to the risk of dependence. Epidural analgesia has emerged as a promising opioid-sparing alternative, but its efficacy compared with conventional opioid-based intravenous patient-controlled analgesia (IV-PCA) in a randomized trial has not been established in these patients.QUESTIONS/PURPOSESWe asked whether an opioid-sparing protocol, compared with conventional opioid-based IV-PCA, (1) provides superior pain control, (2) reduces opioid consumption, and (3) lowers the frequency of opioid-related adverse events.METHODSIn this multicenter, randomized, double-blind, parallel-group trial, we enrolled 98 patients undergoing single-level lumbar fusion or decompression. Eligible participants were adults age 20 to 80 years diagnosed with lumbar spinal stenosis or spondylolisthesis. Exclusion criteria included history of prior lumbar surgery, coagulation disorders, or opioid dependence. Patients were randomized to either the epidural opioid-free IV-PCA group (intraoperative single-shot epidural ropivacaine injection with opioid-free IV-PCA; epidural group) or the conventional opioid-based IV-PCA group (fentanyl-based IV-PCA; control group). In the epidural opioid-free group, fentanyl was administered solely as a rescue analgesic for breakthrough pain. All patients and outcome assessors were blinded to group allocation. In the fusion arm, 25 patients were randomized to the epidural group and 25 to the control group; data from all randomized patients (n = 25 in each group) were fully analyzed. In the decompression arm, 24 were randomized to the epidural group and 24 to the control group; data from all randomized patients (n = 24 in each group) were fully analyzed. Three patients (one in the fusion arm and two in the decompression arm) discontinued the intervention because of severe postoperative nausea and vomiting but were included in the final analysis based on the intention-to-treat principle, preventing differential loss to follow-up bias. There were no important differences between treatment and control groups in terms of baseline demographic or clinical data in either study arm. The minimum clinically important difference (MCID) for the numeric rating scale (NRS) pain score was defined as 2 points. The sample size was calculated to detect a 15% reduction in NRS scores (0.9 points), ensuring sensitivity to differences smaller than the MCID of 2 points. Secondary outcomes included total fentanyl consumption, rescue analgesic demand, and opioid-related adverse events.RESULTSThere were no clinically important differences between the epidural and control groups in either the decompression or the fusion arms of the study in terms of NRS pain scores at any time point (the largest difference was seen at 24 hours in the fusion group, but it was not clinically important: mean ± SD 2.7 ± 1.5 versus 4.4 ± 1.5 points of 10 total, me","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"44 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-06DOI: 10.1097/CORR.0000000000003895
Wakenda K Tyler
{"title":"CORR Insights®: Higher Area Deprivation Index Is Associated With Greater Practice-initiated Perioperative Communication Workload in Patients With Primary Total Joint Arthroplasty.","authors":"Wakenda K Tyler","doi":"10.1097/CORR.0000000000003895","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003895","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-05DOI: 10.1097/corr.0000000000003892
James Rickert
{"title":"On Patient Safety: What We Can Do to Mitigate Antibiotic Resistance.","authors":"James Rickert","doi":"10.1097/corr.0000000000003892","DOIUrl":"https://doi.org/10.1097/corr.0000000000003892","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"6 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-05DOI: 10.1097/corr.0000000000003893
Paul J Dougherty
{"title":"CORR® Curriculum-Orthopaedic Education: Residents Must Learn How to Be Good Team Players Before They Can Become Leaders.","authors":"Paul J Dougherty","doi":"10.1097/corr.0000000000003893","DOIUrl":"https://doi.org/10.1097/corr.0000000000003893","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"156 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-04DOI: 10.1097/corr.0000000000003883
Hiroyuki Tokuyasu,Eiki Tsushima,Mitsuru Takemoto,Claudio Vergari,Hiroshi Kanoe,Youngwoo Kim
BACKGROUNDAlthough patients with THA may increase their use of hip flexion to compensate for loss of spinal motion after lumbar fusion, no studies have directly examined this relationship. Furthermore, the association between the number of fused levels on postoperative compensatory hip motion is not clear, making it difficult to anticipate these changes prior to lumbar fusion.QUESTIONS/PURPOSES(1) Is lumbar fusion after THA associated with resting spinopelvic alignment or compensatory changes at the hip? (2) Is the number of fused spinal segments associated with an increase in hip compensatory motion? (3) Can this increase in hip compensatory motion be anticipated prior to lumbar spine fusion?METHODSBetween January 2017 and December 2023, we retrospectively identified 109 patients with lumbar fusion after THA. The minimum follow-up time after lumbar fusion was set at 6 months to account for implant stabilization and early dislocation events. Of these patients, 59% (64) were excluded because of incomplete questionnaires (17% [19 of 109]), neuromuscular disease (3% [3 of 109]), unavailable or obscured functional lateral radiographs before and/or after lumbar fusion (36% [39 of 109]), or lumbar fusion performed within 6 months after THA (3% [3 of 109]), leaving 41% (45 of 109) of patients for analysis. Among the included patients, 82% (37 of 45) were female, with a mean ± SD age of 74 ± 8 years. Functional lateral radiographs were obtained in three postures (free-standing, relaxed-seated, and flexed-seated) before and after lumbar fusion surgery. From these radiographs, spinopelvic alignment parameters were measured, including pelvic incidence, L1-S1 lumbar lordosis, sacral slope, pelvic tilt, pelvic-femoral angle (PFA), and pelvic incidence minus lumbar lordosis (PI-LL). The hip angle was defined as the PFA value calibrated for pelvic incidence. Lumbar, pelvic, and hip motion were assessed based on the degree of change between each posture. Multivariable regression analysis was performed to examine the association between the number of fused levels and the change in PFA in the flexed-seated position before and after lumbar fusion.RESULTSAfter lumbar fusion, mean ± SD Oswestry Disability Index (ODI) total scores were lower (44% ± 18% versus 22% ± 16%, mean difference -21% [95% confidence interval (CI) -29% to -14%]; p < 0.001). Median (range) ODI item Q1 (back pain) scores were also lower (3 [0 to 5] versus 1 [0 to 3], median difference -2 points [95% CI -3 to -2]; p < 0.001). In the standing position, L1-S1 lumbar lordosis was larger (29° ± 22° versus 34° ± 14°, mean difference 6° [95% CI 1° to 10°]; p = 0.01) and PI-LL was smaller (19° [-13° to 76°] versus 11° [-12° to 76°], median difference -4° [95% CI -9° to 0°]; p = 0.02), while other standing parameters were no different. In the flexed-seated position, L1-S1 lumbar lordosis, PFA, and hip angle were larger after lumbar fusion (L1-S1 lumbar lordosis: -8° ± 14° versus 8° ± 14°, mean difference 1
背景：尽管THA患者可能会增加髋关节屈曲来补偿腰椎融合术后脊柱运动的丧失，但没有研究直接研究这种关系。此外，融合节段数量与术后代偿性髋关节运动之间的关系尚不清楚，因此很难在腰椎融合前预测这些变化。(1)髋关节置换术后腰椎融合是否与静息后的脊柱骨盆对齐或髋关节代偿性改变有关？(2)融合脊柱节段的数量是否与髋关节代偿运动的增加有关？(3)这种髋关节代偿运动的增加是否可以在腰椎融合前预测到？方法：2017年1月至2023年12月，我们回顾性分析了109例THA后腰椎融合患者。腰椎融合术后的最短随访时间为6个月，考虑到植入物稳定和早期脱位事件。在这些患者中，59%（64）因问卷不完整（17%[19 / 109]）、神经肌肉疾病（3%[3 / 109]）、腰椎融合术前后（36%[39 / 109]）或THA后6个月内进行腰椎融合术（3%[3 / 109]）无法获得或遮挡功能侧位片而被排除在外，剩下41%（45 / 109）的患者有待分析。在纳入的患者中，82%（45例中37例）为女性，平均±SD年龄为74±8岁。在腰椎融合术前后分别采用三种姿势（独立式、放松坐姿和屈曲坐姿）拍摄功能侧位片。通过这些x线片，测量脊柱-骨盆对准参数，包括骨盆发生率、L1-S1腰椎前凸、骶骨斜度、骨盆倾斜、骨盆-股骨角（PFA）和骨盆发生率减去腰椎前凸（PI-LL）。髋角被定义为校正骨盆发生率的PFA值。腰椎、骨盆和髋部的运动是根据每个姿势之间的变化程度来评估的。采用多变量回归分析检查腰椎融合术前后屈曲坐姿PFA变化与融合节段数量之间的关系。结果腰椎融合术后，平均±SD Oswestry残疾指数（ODI）总分较低（44%±18% vs 22%±16%），平均差值-21%[95%可信区间(CI) -29% ~ -14%]；P < 0.001)。ODI项目Q1（背部疼痛）得分中位数（范围）也较低（3[0 ~ 5]对1[0 ~ 3]，中位数差-2分[95% CI -3 ~ -2]； p < 0.001）。站立位时，L1-S1腰椎前凸较大（29°±22°vs 34°±14°，平均差6°[95% CI 1°~ 10°]，p = 0.01）， PI-LL较小（19°[-13°~ 76°]vs 11°[-12°~ 76°]，中位差-4°[95% CI -9°~ 0°]，p = 0.02），其他站立位参数无差异。flexed-seated位置,L1-S1腰椎前凸,PFA,髋关节角较大的腰椎融合后(L1-S1腰椎前凸:8°±14°和8°±14°,平均差16°(95% CI 11°22°),p < 0.001; PFA: 83°±17°和97°±16°,平均差14°(95% CI 10°到17°),p < 0.001;髋关节角:93°(51°- 127°)和106°[87°- 132°),平均差13°(95% CI 10°16°),p < 0.001),表明更大的补偿髋关节屈曲。在考虑了年龄、BMI和术前屈曲坐位髋关节角度后，融合节段的数量与腰椎融合后屈曲坐位PFA的增加幅度相关（标准化β = 0.39 [95% CI 0.15至0.62];p = 0.002）。使用多变量模型，可以根据融合节段数和术前屈曲坐位髋关节角度来描述屈曲坐位术后PFA的预期增加幅度（R2 = 0.43; p < 0.001）。以下回归方程用于预测腰椎融合术后代偿运动的增加：ΔPFAflexed-seated = （-0.39 ×术前屈曲-坐位髋关节角度）+ （2.44 ×融合节段数）+ 44.7。结论：我们的研究结果表明，术前对计划行腰椎融合术的THA患者进行屈曲位x线片可能是有帮助的。这些信息有助于脊柱外科医生与患者和髋关节外科医生沟通术后脱位的潜在风险，并支持腰椎融合术前的共同决策。未来使用三维成像或运动捕捉技术的研究将有必要确定腰椎运动丧失与多平面髋关节运动和功能活动中脱位风险之间的关系，特别是在考虑髋臼和股骨假体放置时。证据等级：III级，治疗性研究。
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