Aging Spine Poses Challenges for Acetabular Cup Positioning

Orthopedics Today featured David J. Mayman, MD, hip and knee surgeon at HSS, in their print cover story about how surgeons treat patients with both hip and spine pathology.

For patients who have already undergone total hip arthroplasty (THA) and spinal realignment, the article noted there is a risk of hip dislocation. Dr. Mayman said "we have seen a couple of people over the years who had a hip replacement and were doing fine and then 5 years to 10 years later have a spine fusion, and then end up dislocating their hip. It’s incredibly rare that somebody dislocates their hip 10 years after they have a hip replacement. The only variable was that they had a spine fusion before they dislocated their hip."

To avoid hip dislocation, Dr. Mayman advised surgeons to take lumbar spine radiographs in order to tell if there is lumbar spine pathology before performing a hip replacement. In addition, Dr. Mayman said that using a dual mobility hip socket has been shown to reduce the risk of hip instability and dislocation.

"[This] gives you a much more stable hip. We are starting to use that in a lot of people who have bad spines because we are worried about their hip joint stability."

Dr. Mayman discussed the importance of hip and spine surgeons to collaborate on a treatment plan. The article notes that HSS has a team that includes individuals from the biomechanics laboratory, a spine surgeon, hip surgeons and a radiologist that researches the patient’s hip-spine relationship and determines the best treatment options.

"Ultimately, at the end of the day, the patient does not care whether it is the hip surgeon or the spine surgeon [who treats them]. They want their back to feel good and they want their hip to feel good. We learn things from each other and I think we are treating patients better because we learn things from each other," said Dr. Mayman.

Read the full article at This article also appeared as the cover story of the August 2017 print issue.