Hip Arthroscopy in Patients with Spine Pain: Outcomes Vary Compared to Patients with Isolated Hip Pathology, but Many Hip-Spine Patients Do Just as Well

Abstract

Low back pain present concurrently with hip impingement or labral pathology is frustrating for both patient and surgeon. It is difficult to distinguish true hip pathology from secondary low back symptoms, even with the use of diagnostic injections, cross-sectional imaging, electromyography, and/or nerve conduction studies. In addition, even properly indicated hip arthroscopy can exacerbate sciatic nerve dysfunction, a known complication from traction, and altered gait in the early postoperative period can aggravate sacroiliac and lumbar pathology. Moreover, difficult results vary in these patients after hip arthroscopy, and show higher revision rates and less improvement in functional scores compared to patients with isolated hip pathology. Nevertheless, appropriately selected "hip-spine" patients show significant benefit from hip arthroscopy. Provided they have appropriate counseling, many hip-spine patients can undergo hip arthroscopy and experience a satisfying, durable outcome, and improvements at one year post-operatively are shown to be maintained at five or more years.