Archives of orthopaedic and trauma surgery · 2026
Effect of spinal fusion length on hip and knee osteoarthritis: a comparative cohort study of no fusion, short-segment fusion, and long-segment fusion.
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Sülek Yusuf, Demirkale İsmail, Ertoğrul Rodi, Özdemir Hacı Mustafa
Аннотация
PURPOSE: Lumbar fusion alters spinal-pelvic biomechanics and may influence degenerative changes in the lower extremities. This study investigated whether fusion length is associated with radiographic progression of hip and knee osteoarthritis.
METHODS: In this retrospective, single-center cohort study, patients aged 40-65 years who underwent lumbar surgery between 2010 and 2021 were grouped as no fusion (N), short fusion (S; ≤3 levels), or long fusion (L; ≥4 levels). Hip joint space width was assessed using minimum joint space (MJS) and superointermediate joint space (SJS), including femoral head-standardized measures (sMJS and sSJS). Knee medial joint space width (KMJS) was measured when available. Spinopelvic parameters (LL, PI, PT, SS, PI-LL) and functional outcomes (ODI, HHS, WOMAC) were recorded. Multivariable linear and logistic regression analyses were performed to identify independent predictors of joint space narrowing and osteoarthritis risk.
RESULTS: Hip joint space narrowing differed significantly among groups, with the highest annual narrowing rates in the long-fusion group, followed by the short-fusion group, and the lowest in the no-fusion group (p < 0.001). In contrast, knee KL grade change and annual KMJS narrowing did not differ significantly between groups (p > 0.05). In logistic regression, each additional fused level increased the odds of postoperative MJS ≤ 2.0 mm by 16-19%, and higher CEA was also associated with increased risk.
CONCLUSION: Long-segment lumbar fusion (≥ 4 levels) was associated with greater hip joint space narrowing and greater radiographic progression of hip osteoarthritis, whereas knee degeneration did not differ by fusion status. Patients undergoing extensive fusion may benefit from closer hip surveillance to facilitate earlier recognition of degeneration.
METHODS: In this retrospective, single-center cohort study, patients aged 40-65 years who underwent lumbar surgery between 2010 and 2021 were grouped as no fusion (N), short fusion (S; ≤3 levels), or long fusion (L; ≥4 levels). Hip joint space width was assessed using minimum joint space (MJS) and superointermediate joint space (SJS), including femoral head-standardized measures (sMJS and sSJS). Knee medial joint space width (KMJS) was measured when available. Spinopelvic parameters (LL, PI, PT, SS, PI-LL) and functional outcomes (ODI, HHS, WOMAC) were recorded. Multivariable linear and logistic regression analyses were performed to identify independent predictors of joint space narrowing and osteoarthritis risk.
RESULTS: Hip joint space narrowing differed significantly among groups, with the highest annual narrowing rates in the long-fusion group, followed by the short-fusion group, and the lowest in the no-fusion group (p < 0.001). In contrast, knee KL grade change and annual KMJS narrowing did not differ significantly between groups (p > 0.05). In logistic regression, each additional fused level increased the odds of postoperative MJS ≤ 2.0 mm by 16-19%, and higher CEA was also associated with increased risk.
CONCLUSION: Long-segment lumbar fusion (≥ 4 levels) was associated with greater hip joint space narrowing and greater radiographic progression of hip osteoarthritis, whereas knee degeneration did not differ by fusion status. Patients undergoing extensive fusion may benefit from closer hip surveillance to facilitate earlier recognition of degeneration.