Who Knew That the Hip Was Impacted by the Back?
Your body is connected, a fact that modern medicine often ignores. Why? It’s easiest as a physician to focus on the spot where it hurts. However, when we make changes to the body through surgery, it has impacts. This morning I’d like to review a study that shows that surgically fusing the low back for pain relief can wear out a hip quicker.
The Long List of Hip-Replacement Complications
Spinal fusion aside, which also has its own list of potential complications, hip replacement all on its own can be very painful and even debilitating. The potential complications are numerous, and there have been many, many studies showing just how risky these surgeries really are.
Last month I shared another study showing the connections between low-back conditions and dislocations following hip replacement. In this case the study subjects had a variety of back issues, including everything from arthritis to herniated discs to degenerative disc disease, and subjects with a low-back condition were twice as likely to dislocate their hip replacement. A handful of other complications of hip replacement follow:
- All hip-replacement devices produce toxic wear particles that can lead to things such as high levels of metal ions in the blood, genetic problems in the cells, and pseudotumors.
- Biomechanics of the leg change with a hip replacement, disrupting knee and hip alignment.
- Heart attack risk in men nearly doubles following a hip replacement.
- Hip replacement increases risk of stroke by 400–500%.
- There can be allergies to the metal used in the device, especially if you are a generally allergic person.
- Activity levels unlikely to increase following hip replacement.
- Other complications of hip replacements include blood clots, infections, failed prosthesis, and continued pain.
The Study on Hip Replacement After Lumbar Fusion
The new study investigated the hypothesis that a dislocation of a hip replacement is more common when a patient has had a fusion of the lumbar spine. This was a very large-scale study using all of the patients in the Medicare database, covering an eight-year period, who’d had lumbar fusions prior to a hip replacement. These subjects were compared to a control group of subjects who’d had hip replacements but no spinal fusions. The results showed that subjects who had lumbar fusions prior to having a properly placed hip replacement had higher dislocation rates than hip-replacement subjects who did not have lumbar fusions. In addition, the more levels fused, the higher the dislocation rate, so patients with 3–7 fused levels fared worse than those with 1–2 fused levels.
Authors suggested that flexibility in the lower back and hip while sitting serves as a protective feature, making the hip replacement more stable and preventing impingement of the hip-replacement device. The fusion reduces the movement, or flexibility, thereby possibly eliminating the stability of the prosthetic hip and leading to a greater risk for dislocation.
The upshot? Who knew that the back impacted the hip? Oh wait, if you’ve been reading this blog, you knew. The funny thing is that by understanding that it’s all connected, you know more than most physicians who still look at the body as segmented parts. So go teach your doctor that your body is a whole machine, not just a hip, back, knee, or ankle!