Summary

Although it may take > 2 years, patients with hip-spine syndrome can attain clinically meaningful improvement in hip pain following hip arthroscopy for FAI.

Abstract

Introduction

The overlapping biomechanical relationship between the lumbosacral spine and pelvis poses a unique challenge to patients with abnormalities that limit range of motion through the hip. We aim to assess the influence of concomitant lumbosacral spine pathology on patient-reported outcome metrics (PROMs) and rates of achieving clinical thresholds (e.g., minimal clinically important difference [MCID] and patient-acceptable symptom states [PASS]) following hip arthroscopy for the treatment of symptomatic labral tears in patients with femoroacetabular impingement (FAI).

Methods

A retrospective review of a prospectively collected, single-surgeon database was performed to identify patients =18 years of age with minimum 2-year follow-up, who underwent primary hip arthroscopy for the treatment of labral tears secondary to FAI. No patients had previous ipsilateral hip or spine surgery. Patients were stratified into cohorts based on the presence (hip-spine [HS]) or absence (matched-control [MC]) of lumbosacral spine disease, and cohorts were coarsened exact matched on age, sex, and body mass index. Inclusion within the HS cohort required lower back pain plus a diagnosis of lumbosacral spine disease verified radiologically. PROMs and frequency of achieving MCID/PASS thresholds were compared between groups. Outcomes included modified Hip Harris Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), International Hip Outcome Tool-33 (iHOT-33), Non-Arthritic Hip Score (NAHS), visual analogue scale (VAS) pain, rates of revision arthroscopy, and conversion to total hip arthroplasty (THA).

Results

70 patients with lumbosacral disease were matched to 87 controls. Preoperative scores were significantly worse in the HS cohort for all but one outcome (P <.05 for all, except HOS-ADL). Subsequent follow-ups at 3-, 6-, 12-, and 24-months displayed similar trends, with the HS cohort demonstrating significantly worse scores for nearly every PROM. However, HS and MC patients exhibited statistically similar magnitudes of improvement in all outcomes at every time point (P > .05). Thus, by 3- and 5-year follow-up, the HS cohort achieved statistically similar outcome scores across all PROMs (P >.05). Achievement of MCID thresholds occurred at similar rates between cohorts across nearly all PROMs at 12-month, 24-month, and 5-year follow-up. PASS analysis revealed significantly lower frequencies among the HS cohort for nearly all PROMS at 12- and 24- months; however, available 5-year data trended toward similar rates (P >.05 for all). No significant differences in the rates of revision or conversion to total hip arthroplasty were identified between cohorts (P > .05 for both).

Conclusion

Following hip arthroscopy to address labral tears in the setting of FAI, patients with diagnosed lumbosacral pathologies and no prior history of spine surgery experienced statistically similar clinical benefit and rates of functional improvement at 2-year follow-up relative to matched controls with isolated hip disease. Our results suggest that patients with concurrent lumbosacral pathologies can experience improvement beyond 24-month follow-up, and medium- to long-term follow-up may be necessary to define clinically meaningful outcomes most accurately in the setting of arthroscopic hip preservation surgery. Overall, our data provide evidence that coexisting hip and spine disorders are not a contraindication for arthroscopic hip preservation surgery.