ePoster #731 - ISHA Annual Scientific Meeting 2016
Concomitant Lumbar Spine Pathology In Patients Undergoing Hip Arthroscopy: A Matched Cohort Analysis
Michael K Ryan, MD, New York, NY UNITED STATES
Siddharth Mahure, MD, New York, NY UNITED STATES
Aaron Buckland, MD, New York UNITED STATES
Mathew Hamula, MD, New York, NY UNITED STATES
John P Begly, MD, New York, NY UNITED STATES
Brian Capogna, MD, New York, NY UNITED STATES
Christopher A Looze, MD, New York, NY UNITED STATES
Kristofer Chenard, MD, New York, NY UNITED STATES
Theodore Wolfson, MD, New York, NY UNITED STATES
Thomas Youm, MD, New York, NY UNITED STATES
NYU Hospital for Joint Diseases, New York, NY, UNITED STATES
FDA Status Cleared
Summary: This study is a matched cohort analysis comparing 2 year patient reported outcomes after hip arthroscopy of patients with and without lumbar spinal pathology.
Background: As femoroacetabular impingement (FAI) and related intra- and extra-articular hip pathology become more recognized due to increased awareness, hip arthroscopy for treatment of hip disease has increased. While radiographic findings may indicate potential causes of pain, clinical diagnosis remains a mainstay in the diagnosis of hip-related pain and dysfunction. Yet variable presentations of hip pain often lead to confusion with lumbar spine pathology. The relationship between lumbosacral anatomy and acetabular position is being elucidated, yet there is little data suggesting how concurrent lumbar spine pathology affects patients undergoing hip arthroscopy for confirmed hip pathology.
Purpose: The purpose of this study was to further define the relationship between the lumbar spine and the hip joint. Patients undergoing hip arthroscopy with concurrent lumbar spine disease were identified and compared to those without lumbar spine pathology. Our hypothesis is that patients with concurrent lumbar spine pathology undergoing hip arthroscopy for confirmed hip pathology experience inferior outcomes compared to patients without lumbar spine pathology at 2 years.
Methods: A retrospective review of a prospectively-collected, single-surgeon database from 2010 to 2014 was used to identify patients who had undergone hip arthroscopy who exhibited documented, concurrent lumbar spine pathology. Patients were included if they were skeletally-mature, had no prior hip surgery, had pain that failed non-operative treatment resulting from confirmed hip hip pathology, and had imaging of the lumbar spine (plain radiographs, commuted tomography or magnetic resonance imaging). Patients without complete two-year follow-up were excluded. Patients with spine pathology were matched by age, gender, and BMI in a 3:1 fashion to patients without spine pathology (defined as “normal”). Baseline pre-operative modified Harris Hip Scores (mHHS) were compared to scores at two-year follow-up. “Poor outcome” of initial hip arthroscopy was defined as any combination of: requiring a revision procedure or conversion to THA or mHHS below 70.
Results: 167 patients met inclusion criteria: 72.5% (121/167) were “normal” while 27.5% (46/167) had spine pathology. Baseline demographics were appropriately matched between cohorts and can be found in Table I. Preoperative and two-year mHHS scores were significantly different between cohorts (Figure 1). Both cohorts demonstrated significant within group improvement at two-year follow-up, however with normal patients improving a mean of 34.0 (p<0.001), while those with spine pathology improved 31.76 (p<0.001). Overall revision/THA conversion rate for entire cohort was 14.97% (25/167), with nearly twice as many spine co-pathology patients requiring additional surgery than those in the normal cohort (23.91% vs 11.57%, p=0.045). Analysis for “poor outcomes” found that patients with spine pathology were significantly more likely to have suboptimal results than those without (36.96% vs 21.49%, p=0.048).
Conclusion: It is known that isolated pathology of the non-arthritic hip can be successfully treated by hip arthroscopy to decrease pain, increased function and allow patients to return to activities beyond daily life. Concomitant musculoskeletal co-morbidities may limit potential maximal results. As seen in this study, patients with concomitant lumbar spine pathology demonstrate significantly lower total improvement, significantly higher revision or conversion rates and significantly higher rates of suboptimal outcomes after hip arthroscopy.