Impact of Lower Extremity Arthroplasty on Improvement of Quality-of-Life Outcomes Following Lumbar Fusion

T. Barrett Sullivan; Conor P. Lynch; Elliot D.K. Cha; Cara E. Geoghegan; Caroline N. Jadczak; Shruthi Mohan; Kern Singh

doi:10.14444/8335

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Table 1

Patient demographics.

Characteristic	Total (n = 335)	No Arthroplasty (n = 310)	Arthroplasty (n = 25)	P Value^{^a}
Age, y, mean ± SD	53.1 ± 10.9	52.5 ± 10.9	61.4 ± 7.4	0.001
Body mass index, mean ± SD	30.8 ± 6.3	30.7 ± 6.3	31.9 ± 5.9	0.340
Gender				0.251
Female	37.3% (125)	36.5% (113)	48.0% (12)
Male	62.7% (210)	63.5% (197)	52.0% (13)
Diabetic status				0.645
Nondiabetic	89.3% (299)	89.0% (276)	92.0% (23)
Diabetic	10.7% (36)	11.0% (34)	8.0% (2)
Smoking status				-
Nonsmoker	100% (335)	100% (310)	100% (25)
Smoker	0.0% (0)	0.0% (0)	0.0% (0)
American Society of Anesthesiologists score				0.535
<2	83.6% (280)	85.2% (258)	88.0% (22)
≥2	16.4% (55)	16.8% (52)	12.0% (3)
Charlson Comorbidity Index score				0.003
<1	29.9% (100)	31.9% (99)	4.0% (1)
≥1	70.1% (235)	68.1% (211)	96.0% (24)
Insurance				0.025
Medicare/Medicaid	4.2% (14)	4.2% (19)	4.0% (1)
Workers’ compensation	26.9% (90)	28.7% (89)	4.0% (1)
Private	68.9% (231)	67.1% (208)	92.0% (23)
Comorbid diagnoses
Myocardial infarction	2.7% (9)	2.6% (8)	4.0% (1)	0.673
Hypertension	30.7% (103)	31.0% (96)	28.0% (7)	0.757
Chronic lung disease	1.8% (6)	1.3% (4)	8.0% (2)	0.015

Note: Boldface indicates significance.
↵a P values calculated using χ ² or t test.

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Table 2

Perioperative characteristics.

Characteristic	Total (n = 335)	No Arthroplasty (n = 310)	Arthroplasty (n = 25)	P Value^a
Spinal pathology
Recurrent herniated nucleus pulposus	12.8% (43)	13.5% (42)	4.0% (1)	0.110
Degenerative spondylolisthesis	51.6% (148)	49.8% (131)	70.8% (17)	0.049
Isthmic spondylolisthesis	33.8% (96)	34.6% (90)	25.0% (6)	0.341
Degenerative scoliosis	10.8% (36)	10.0% (31)	20.0% (5)	0.120
Number of levels				0.283
Single	90.1% (302)	90.7% (281)	84.0% (21)
Multilevel	9.9% (33)	9.3% (29)	16.0% (4)
Operative time, min, mean ± SD	142.6 ± 49.4	142.6 ± 48.9	142.3 ± 57.4	0.978
Estimated blood loss, mL, mean ± SD	55.8 ± 35.9	55.0 ± 33.8	66.7 ± 56.9	0.126
Length of stay, h, mean ± SD	38.1 ± 26.2	38.1 ± 26.3	38.3 ± 24.7	0.981

Note: Boldface indicates significance.
↵a P values calculated using χ ² test or t test.

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Table 3

Differences in mean patient-reported outcome measures by arthroplasty group.

Patient-Reported Outcome Measure	No Arthroplasty (Mean ± SD)	P Value^{^a}	Arthroplasty (Mean ± SD)	P Value^{^a}	P Value^{^b}
Oswestry Disability Index
Preoperative	42.5 ± 16.8	-	39.8 ± 13.9	-	0.424
6 wk	35.8 ± 19.3	<0.001	35.4 ± 19.8	0.145	0.928
12 wk	29.6 ± 18.4	<0.001	25.2 ± 22.6	0.002	0.323
6 mo	24.9 ± 19.6	<0.001	19.2 ± 18.7	<0.001	0.226
1 y	23.3 ± 21.7	<0.001	25.4 ± 23.8	0.005	0.736
2 y	23.4 ± 22.0	<0.001	34.9 ± 33.8	0.177	0.167
12-Item Short Form Physical Component Summary
Preoperative	30.8 ± 8.9	-	30.4 ± 8.0	-	0.850
6 wk	31.6 ± 8.7	0.079	34.1 ± 9.7	0.149	0.238
12 wk	35.4 ± 10.1	<0.001	40.0 ± 11.0	0.005	0.063
6 mo	39.3 ± 11.7	<0.001	39.9 ± 11.3	<0.001	0.831
1 y	40.5 ± 12.0	<0.001	42.6 ± 12.0	0.001	0.484
2 y	41.6 ± 11.7	<0.001	37.0 ± 13.8	0.261	0.245
Patient-Reported Outcomes Measurement Information System Physical Function
Preoperative	35.1 ± 6.4	-	37.7 ± 6.5	-	0.171
6 wk	37.2 ± 6.4	0.001	40.1 ± 6.0	0.031	0.141
12 wk	40.8 ± 6.8	<0.001	42.8 ± 8.9	0.020	0.297
6 mo	44.3 ± 7.2	<0.001	41.7 ± 9.7	0.064	0.271
1 y	44.7 ± 9.1	<0.001	47.5 ± 11.7	0.009	0.302
2 y	45.0 ± 9.3	<0.001	47.7 ± 9.2	0.018	0.374
VAS back
Preoperative	6.6 ± 2.4	-	5.5 ± 2.5	-	0.029
6 wk	4.0 ± 2.5	<0.001	3.1 ± 2.2	0.003	0.132
12 wk	3.6 ± 2.6	<0.001	3.6 ± 3.0	0.172	0.991
6 mo	3.4 ± 2.7	<0.001	2.5 ± 2.7	0.001	0.133
1 y	3.2 ± 2.9	<0.001	2.6 ± 2.8	0.009	0.933
2 y	3.4 ± 2.8	<0.001	3.9 ± 3.5	0.099	0.781
VAS leg
Preoperative	5.8 ± 2.8	-	5.7 ± 2.1	-	0.780
6 wk	3.2 ± 2.9	<0.001	3.5 ± 2.8	0.003	0.706
12 wk	2.8 ± 2.7	<0.001	3.0 ± 3.2	0.002	0.703
6 mo	2.7 ± 2.8	<0.001	2.7 ± 2.9	0.001	0.992
1 y	2.7 ± 3.0	<0.001	3.4 ± 3.1	0.009	0.390
2 y	2.4 ± 2.8	<0.001	3.6 ± 3.6	0.104	0.262

Abbreviation: VAS, visual analog scale.
Note: Boldface indicates statistical significance.
↵a P values calculated using paired t test.
↵b P values calculated using linear regression.

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Table 4

Rates of minimum clinically important difference achievement by arthroplasty group.

Outcome Measure	6 wk	12 wk	6 mo	1 y	2 y	Overall
Oswestry Disability Index
No arthroplasty	36.6%	44.2%	55.1%	60.6%	62.7%	65.1%
Arthroplasty	42.9%	52.6%	78.9%	78.6%	44.4%	72.0%
P value^{^a}	0.573	0.479	0.035	0.172	0.296	0.477
12-Item Short Form Physical Component Summary
No arthroplasty	30.4%	48.1%	57.1%	68.0%	64.0%	69.4%
Arthroplasty	33.3%	55.6%	47.1 %	66.7%	44.4%	69.6%
P value^{^a}	0.796	0.586	0.434	0.917	0.256	0.987
Patient-Reported Outcomes Measurement Information System Physical Function
No arthroplasty	15.8%	29.1%	48.2%	51.1%	56.0%	59.3%
Arthroplasty	20.0%	30.0%	33.3%	30.0%	42.9%	63.6%
P value^{^a}	0.735	0.950	0.386	0.199	0.505	0.774
VAS back
No arthroplasty	67.7%	70.9%	73.1%	75.4%	71.6%	84.1%
Arthroplasty	65.0%	55.6%	66.7%	76.9%	62.5%	79.2%
P value^{^a}	0.799	0.183	0.561	0.902	0.598	0.539
VAS leg
No arthroplasty	62.5%	65.5%	63.6%	64.6%	59.9%	79.6%
Arthroplasty	38.1%	47.4%	57.9%	57.1%	55.6%	72.0%
P value^{^a}	0.029	0.119	0.626	0.587	0.395	0.389