The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: A Nested Case-Control Analysis

Abstract

Background: Previous literature has examined the association between lumbosacral pathology and hip pathomechanics. However, the effect of lumbosacral pathologies and previous lumbosacral surgery on achieving meaningful outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has yet to be studied conclusively. Purpose: To determine whether a history of lumbosacral spine pathology has an influence on achieving minimal clinically important differences (MCIDs) after hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing hip arthroscopy for FAIS by a single, fellowship-trained orthopaedic surgeon between January 2012 and April 2017 with minimum 2-year follow-up were retrospectively reviewed. Patients with a history of lumbosacral spine pathology (eg, lumbosacral fusion, disc or vertebral pathology, or history of lumbosacral fractures) were matched 1:2 by age, body mass index, and sex to patients without spine pathology. Clinical outcomes including the Hip Outcome Score–activities of daily living subscale (HOS-ADL), HOS–sports subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool–12 (iHOT-12), visual analog scale (VAS) pain, and VAS satisfaction were compared between the groups using an independent t test. The threshold of every outcome score for achieving MCID was calculated separately for each group and frequencies were compared. Results: A total of 83 of 108 eligible patients with lumbosacral pathology were identified and matched to 166 patients without any spine pathology. When compared with the non–spine pathology group, the lumbosacral pathology group had significantly lower 2-year postoperative outcome score averages across all reported outcome tools (all P < .001). There were significant differences in the proportion achieving the threshold for HOS-ADL (60.6% vs 80.0%; P = .004), HOS-SS (57.6% vs 82.1%; P < .001), mHHS (66.7% vs 81.7%; P = .025), and iHOT-12 (54.8% vs 87.6%; P < .001) scores for MCID when comparing the lumbosacral and nonlumbosacral pathology groups. Conclusion: Patients with a history of lumbosacral pathology achieved significantly lower short-term meaningful clinical outcomes after undergoing hip arthroscopy for FAIS when compared with patients without spine pathology. The present study findings have implications for preoperative patient screening, shared decision-making processes/expectation management, and rehabilitation strategies.

Editorial Commentary: Lumbosacral Anatomy and Mechanics Influence Femoroacetabular Impingement Syndrome and Surgical Outcomes: The Hip Bone Is Connected to the Back Bone

“…pathology, although it is important to note that patients did significantly improve from their preoperative baseline, nevertheless. 15,16 Given the evidence that spine pathology causing decreased motion results in potentially inferior outcomes following hip arthroscopy, it follows that anatomic variants that alter spinopelvic mechanics may have similar effects. Luo, Barsoum, Ashraf, Cheng, Hurwitz, Goldsmith, and Moley help advance our understanding of the complex relationship between lumbosacral anatomy and mechanics and hip outcomes with their study in the current issue, "Prevalence of Lumbosacral Transitional Vertebrae in Patients With Symptomatic Femoroacetabular Impingement Requiring Hip Arthroscopy."…”

The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: Response

“…As the authors pointed out, this is demonstrated in our current study as well as in previous studies evaluating the effect of spinal disorders on outcomes after addressing hip pathology. [1][2][3]5 Additionally, our team has also published a number of studies that have indicated improvements in functional outcomes after undergoing hip arthroscopy in patients with multiple joint pathologies, including spine, 4 after surgical treatment of gluteus medius tear in patients with spinopelvic deformities and after arthroscopic correction of femoroacetabular impingement syndrome (FAIS) in patients with sacroiliac joint abnormalities. It is important to note, however, that the studies mentioned above comparing functional scores between patients with spine aberration and those without a history of spinal disorders all demonstrate lower functional score averages in the spinal pathology group.…”

The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: Letter to the Editor

“…Recently, we read the article entitled ''The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: A Nested Case-Control Analysis'' by Beck et al 1 They found that compared with the no lumbosacral pathology group, the lumbosacral pathology group achieved significantly worse short-term meaningful clinical outcomes after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We appreciate the work that has been done by the authors and think this finding is of value for clinicians in decision-making.…”