Medical Student UT Southwestern Medical Center Dallas, TX, US
Introduction: The optimal management strategy for patients requiring both spinal fusion and lower limb arthroplasty remains controversial, with limited data on concurrent procedure outcomes. The purpose of this study is to evaluate clinical and radiological outcomes of patients undergoing posterior spinal fusion with or without concurrent lower limb surgery, and to analyze differences between hip and knee arthroplasty subgroups.
Methods: 45 patients undergoing posterior spinal fusion between 2016 and 2023; 18 with concurrent lower limb surgery (12 knee, 6 hip) and 27 without were included in this study. Primary outcomes included ODI, VAS scores, and PROMIS Physical Function. Secondary outcomes included radiographic parameters (PI, LL, SVA) and fusion status. Patients were evaluated at baseline, 3, 6, and 12 months postoperatively. Mixed effects models assessed longitudinal outcomes. Subgroup analyses compared knee versus hip surgery outcomes.
Results: The concurrent surgery group showed greater improvements in ODI at 3 months (12.8 ± 18.1 vs 8.4 ± 15.2, p=0.042) despite being older (73.2 ± 6.8 vs 66.8 ± 9.4 years, p=0.015) with higher BMI (28.9 ± 7.2 vs 25.4 ± 5.1 kg/m², p=0.048). Knee surgery patients demonstrated superior outcomes compared to hip surgery in both clinical and radiological parameters. Fusion rates were similar between groups (72.2% vs 74.1%, p=0.782).
Conclusion : Concurrent lower limb surgery, particularly knee arthroplasty, may enhance outcomes in posterior spinal fusion patients through improved biomechanical alignment, despite traditionally negative prognostic factors.
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