Hip–Spine Syndrome in the Nonarthritic Patient

Vaswani, Ravi; White, Alexander E.; Feingold, Jake; Ranawat, Anil S.

doi:10.1016/j.arthro.2022.04.015

Cited by 15 publications

(11 citation statements)

References 72 publications

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“…For patients with FAI and concomitant lumbosacral symptoms, current literature largely indicates a need for additional studies to better guide preoperative education and the shared decision-making process. 50 The results of this study demonstrated that both HS and MC patients achieved significant functional improvement in all PROMs through their 24-month follow-up, with comparable rates of revision hip arthroscopy, conversion to THA, and self-reported satisfaction at maximum available follow-up. Although patients with lumbosacral pathology (HS cohort) were generally found to have nominally worse pre- and postoperative PROMs compared with MC patients, both cohorts were found to exhibit similar magnitudes of improvement over time.…”

Section: Discussionmentioning

confidence: 62%

“…50 Secondary HS syndrome can affect any age demographic and largely stems from the tandem of compensatory stresses from either structure that exacerbates symptoms in the other. 50 In the early stages of FAI, studies indicate that lumbosacral mobility may be crucial to maintain sagittal balance and counteract the restricted range of motion (ROM) through the hip. 13,23,50 However, over time, compensatory variations in lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope can accelerate arthrosis in facet joints, leading to lower back pain, stiffness, and possible lumbar stenosis.…”

mentioning

confidence: 99%

“…50 In the early stages of FAI, studies indicate that lumbosacral mobility may be crucial to maintain sagittal balance and counteract the restricted range of motion (ROM) through the hip. 13,23,50 However, over time, compensatory variations in lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope can accelerate arthrosis in facet joints, leading to lower back pain, stiffness, and possible lumbar stenosis. 13,15,50 Ultimately, loss of spinopelvic mobility may exacerbate hip-specific symptoms in patients with FAI, as activities requiring high degrees of hip flexion (eg, sitting, squatting) inherently perpetuate mechanical injury to the chondrolabral complex.…”

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confidence: 99%

“…34 However, for a subset of patients with concomitant lumbosacral spine disease and overlapping hip symptomatology, surgeons may be challenged in isolating the predominant cause of pain and identifying appropriate surgical candidates. 50 Hip-spine (HS) syndrome was originally described by Offierski and MacNab 40 in reference to concurrent hip osteoarthritis and lumbar spine degenerative disease commonly seen in the elderly population. However, since that time, investigations into the biomechanical relationship between the lumbar spine, pelvis, and hip have revealed that alterations in spinopelvic motion may have negative implications for younger patients with limited evidence of osteoarthritis.…”

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confidence: 99%

“…13,23,50 However, over time, compensatory variations in lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope can accelerate arthrosis in facet joints, leading to lower back pain, stiffness, and possible lumbar stenosis. 13,15,50 Ultimately, loss of spinopelvic mobility may exacerbate hipspecific symptoms in patients with FAI, as activities requiring high degrees of hip flexion (eg, sitting, squatting) inherently perpetuate mechanical injury to the chondrolabral complex. 13,15 The link between spinopelvic mobility and pelvic sagittal alignment has been well-documented in THA literature, where extremes of pelvic alignment, lumbar disease, previous fusion surgery, and stiffness have been associated with impingement, dislocation, early failure, and need for revision surgery.…”

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confidence: 99%

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Outcomes of Hip Arthroscopy in the Setting of Concomitant Symptomatic Lumbosacral Spine Pathology: A Matched Control Study With Minimum 24-Month Follow-up

Torabian,

Cherian,

Dean

et al. 2023

Am J Sports Med

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Background: The overlapping biomechanical relationship between the lumbosacral spine and pelvis poses unique challenges to patients with concomitant pathologies limiting spinopelvic range of motion. Purpose: To assess the influence of concomitant, symptomatic lumbosacral spine pathology on patient-reported outcome measures (PROMs) after hip arthroscopy for the treatment of femoroacetabular impingement (FAI) and symptomatic labral tears. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective query of prospectively collected data identified patients aged ≥18 years with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to FAI. Patients were stratified into cohorts based on the presence (hip-spine [HS]) or absence (matched control [MC]) of symptomatic lumbosacral spine pathology. Inclusion within the HS cohort required confirmation of lower back pain/symptoms on preoperative surveys plus a diagnosis of lumbosacral spine pathology verified by radiology reports and correlating clinical documentation. Patients with previous spine surgery were excluded. PROMs were compared between groups, along with rates of achieving minimal clinically important difference (MCID) thresholds, Patient Acceptable Symptom State (PASS) thresholds, revision arthroscopy, and conversion to total hip arthroplasty (THA). Results: A total of 70 patients with lumbosacral pathology were coarsened exact matched to 87 control patients without spinal pathology. The HS cohort had preoperative baseline scores that were significantly worse for nearly all PROMs. Follow-ups at 3, 6, 12, and 24 months displayed similar trends, with the HS cohort demonstrating significantly worse scores for most collected outcomes. However, at every time point, HS and MC patients exhibited similar magnitudes of improvement across all PROM and pain metrics. Furthermore, while significantly fewer HS patients achieved PASS for nearly all PROMs at 12- and 24-month follow-ups, MCID thresholds were reached at similar or greater rates across all PROMs relative to the MC cohort. Finally, there were no significant differences in rates of revision or THA between cohorts at maximum available follow-up. Conclusion: After hip arthroscopy to address labral tears in the setting of FAI, patients with symptomatic lumbosacral pathologies and no history of spine surgery were found to exhibit inferior pre- and postoperative PROMs but achieved statistically similar clinical benefit and rates of PROM improvement through 24-month follow-up compared with the MC cohort with isolated hip disease. These findings aid in providing a realistic recovery timeline and evidence that coexisting hip and spine disorders are not a contraindication for arthroscopic hip preservation surgery.

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Section: Discussionmentioning

confidence: 62%