HIP-SPINE RELATIONSHIP

The strength of this option was downgraded to consensus for several reasons including the heterogeneity of the data reported and the timepoints they were reported as well as the fact that future research will have a strong influence on this option in the future. Five low quality articles (Del Sole 2017, Barry 2017, Huang 2019, Salib 2019, Mohamed 2022) that investigated the relationship between osteoarthritis of the hip and stiff spine syndrome met inclusion criteria. While all five articles reported no significant association with dislocation, one article (Barry 2017) showed stiff spine syndrome was associated with more complications and higher reoperation rates.

Benefits/Harms of Implementation

Dislocation remains one of the leading complications after total hip arthroplasty. The hip spine relationship has the potential to increase the risk of this complication, but there is a lack of concrete data. The spine has potential of negatively affecting total hip arthroplasty outcome, but it's not proven by robust data. Dislocation could be a devastating complication. However, patients with stiff spines should not be denied total hip arthroplasty. There should be open discussion between surgeon and patient about potential complications.

Outcome Importance

Dislocations after total hip arthroplasty are a devastating complication. Factors that may increase this risk, such as a stiff spine, should be considered in total hip arthroplasty. Specific changes in implant choices or implant position may be considered in these patients.

Cost Effectiveness/Resource Utilization

To mitigate the risk of dislocations, the use of dual mobility constructs and large femoral heads has increased, both of which increase the costs of surgery. In addition, there has been an increased adoption of technology in total hip arthroplasty to mitigate the risk of dislocation particular in high-risk patients such as those with stiff spines, which increases both the resource utilization and costs in total hip arthroplasty.

Acceptability

The effect of stiff spine on total hip arthroplasty is relatively well appreciated by arthroplasty surgeons. There should not be any impediments in accepting the option.