Summary

Hip arthroscopy for the treatment of FAI and labral tear in patients with prior lumbar spine surgery yielded significant improvements at mid-term, which were equivalent to a benchmark matched control group with no history of lumbar pathology.

Abstract

Purpose

Previous lumbar spine surgery (LSS) may restrict spinal mobility, impacting pelvic mechanics and potentially increasing hip motion demands. The purpose of this study is to evaluate the impact of prior LSS on the outcomes of primary hip arthroscopy at minimum 5-year follow-up.

Methods

A retrospective analysis was conducted on patients who underwent hip arthroscopy with prior LSS. Patients included had completed minimum of 5-year follow-up. A sub-analysis based on the type of lumbar surgery was also conducted. Patients were matched to a control group who underwent hip arthroscopy without spine pathology in a 1:3 ratio based on age at surgery, sex, Acetabular Outerbridge Grade, and body mass index (BMI). Comparisons of hip arthroscopy outcome thresholds, complications, revision hip arthroscopy and conversion to total hip arthroplasty (THA) rates were included.

Results

There were 424 patients included in the study. Patients with prior LSS displayed improvements across all PROs. There were no differences in improvement or the percentage of patients reaching hip arthroscopy thresholds based on the type of LSS. When compared to the benchmark control cohort patients in the prior LSS group started with significantly lower PROs scores. Yet, both groups experienced equivalent improvement for all PROs. Furthermore, the LSS group had worse postoperative scores for all PROss. Additionally, the study group reached the PASS at significantly lower rates for mHHS, NAHS, and HOS-SSS. There was no difference rates of complications and secondary surgery, but the LSS group converted to THA sooner, with the LSS and non-LSS group converting to THA at 27.43 ± 24.32 and 25.77 ± 24.80 months (p < 0.05).

Conclusion

Hip arthroscopy for the treatment of FAI and labral tear in patients with prior LSS yielded significant improvements at mid-term, which were equivalent to a benchmark matched control group with no history of lumbar pathology. However, the prior LSS group achieved lower overall postoperative PRO scores and met the PASS for hip arthroscopy at lower rates. Importantly, LSS did not have an impact on the risk of revision arthroscopy and conversion to THA rates. However, the study group converted to THA sooner.