Summary

This study reports on patient-reported outcomes (PROs) and clinical psychometric evaluations for patients undergoing primary hip arthroscopy with history of lumbar spine surgery.

Abstract

Background

There is a paucity of literature measuring patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) or labral tears with previous lumbar spine surgery at minimum 5-year follow-up.

The purpose is to report patient-reported outcomes (PROs) and clinical psychometric evaluations for patients undergoing primary hip arthroscopy with history of lumbar spine surgery to a control group of patients undergoing primary hip arthroscopy without history of lumbar spine surgery.

Methods

Data was prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy for FAIS or labral tears that received a previous lumbar spine surgery between April 2008 and July 2015. Lumbar spine surgeries were defined as a decompression or fusion. Patients were marked eligible if they completed preoperative and minimum 5-year patient-reported outcome (PROs) questionnaires for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS) for pain. Patients were excluded if they had a previous hip condition (such as fractures, slipped capital femoral epiphysis, avascular necrosis, or Legg-Calve-Perthes disease), were unwilling to participate in the YYY registry, had a Tönnis osteoarthritis grade greater than 1, or had a previous hip surgery on the ipsilateral hip. The lumbar spine group was propensity-score matched in a 1:3 ratio to a group of control patients.

Results

A total of 43 hips were eligible and 36 hips (83.7%) had minimum 5-year follow-up. The lumbar spine cohort experienced significant (P < 0.001) and comparable improvement to group of control patients across all PROS. However, the lumbar spine group demonstrated lower preoperative NAHS (48.13 ± 17.1 vs 55.53 ± 18.4) and HOS-SSS (24.96 ± 23.1 vs 34.75 ± 24.5) scores compared to the the control group, respectively (P = 0.035 and 0.025). Additionally, both the lumbar spine and control groups achieved high rates of MCID in the mHHS (87.0% vs 79.8%, respectively P = 0.555) and NAHS (82.6% vs 83.3%, respectively P > 0.999).

Conclusion

Despite history of previous spine surgery, patients undergoing primary hip arthroscopy achieved comparable rates of improvement, and postoperative scores at the minimum 5-year mark when analyzed against a control group undergoing primary hip arthroscopy without previous lumbar spine surgery. Additionally, both groups were able to achieve high proportions of MCID in the mHHS, and NAHS.