PMID- 37715499 OWN - NLM STAT- MEDLINE DCOM- 20231009 LR - 20231015 IS - 1552-3365 (Electronic) IS - 0363-5465 (Print) IS - 0363-5465 (Linking) VI - 51 IP - 12 DP - 2023 Oct TI - Outcomes of Hip Arthroscopy in the Setting of Concomitant Symptomatic Lumbosacral Spine Pathology: A Matched Control Study With Minimum 24-Month Follow-up. PG - 3268-3279 LID - 10.1177/03635465231197374 [doi] AB - BACKGROUND: The overlapping biomechanical relationship between the lumbosacral spine and pelvis poses unique challenges to patients with concomitant pathologies limiting spinopelvic range of motion. PURPOSE: To assess the influence of concomitant, symptomatic lumbosacral spine pathology on patient-reported outcome measures (PROMs) after hip arthroscopy for the treatment of femoroacetabular impingement (FAI) and symptomatic labral tears. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective query of prospectively collected data identified patients aged >/=18 years with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to FAI. Patients were stratified into cohorts based on the presence (hip-spine [HS]) or absence (matched control [MC]) of symptomatic lumbosacral spine pathology. Inclusion within the HS cohort required confirmation of lower back pain/symptoms on preoperative surveys plus a diagnosis of lumbosacral spine pathology verified by radiology reports and correlating clinical documentation. Patients with previous spine surgery were excluded. PROMs were compared between groups, along with rates of achieving minimal clinically important difference (MCID) thresholds, Patient Acceptable Symptom State (PASS) thresholds, revision arthroscopy, and conversion to total hip arthroplasty (THA). RESULTS: A total of 70 patients with lumbosacral pathology were coarsened exact matched to 87 control patients without spinal pathology. The HS cohort had preoperative baseline scores that were significantly worse for nearly all PROMs. Follow-ups at 3, 6, 12, and 24 months displayed similar trends, with the HS cohort demonstrating significantly worse scores for most collected outcomes. However, at every time point, HS and MC patients exhibited similar magnitudes of improvement across all PROM and pain metrics. Furthermore, while significantly fewer HS patients achieved PASS for nearly all PROMs at 12- and 24-month follow-ups, MCID thresholds were reached at similar or greater rates across all PROMs relative to the MC cohort. Finally, there were no significant differences in rates of revision or THA between cohorts at maximum available follow-up. CONCLUSION: After hip arthroscopy to address labral tears in the setting of FAI, patients with symptomatic lumbosacral pathologies and no history of spine surgery were found to exhibit inferior pre- and postoperative PROMs but achieved statistically similar clinical benefit and rates of PROM improvement through 24-month follow-up compared with the MC cohort with isolated hip disease. These findings aid in providing a realistic recovery timeline and evidence that coexisting hip and spine disorders are not a contraindication for arthroscopic hip preservation surgery. FAU - Torabian, Kaveh A AU - Torabian KA AUID- ORCID: 0000-0003-4265-7345 AD - Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Cherian, Nathan J AU - Cherian NJ AUID- ORCID: 0000-0002-1524-3908 AD - Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA. FAU - Dean, Michael C AU - Dean MC AUID- ORCID: 0000-0001-5996-6393 AD - Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Eberlin, Christopher T AU - Eberlin CT AD - Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa, USA. FAU - Kucharik, Michael P AU - Kucharik MP AD - Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA. FAU - Dowley, Kieran S AU - Dowley KS AUID- ORCID: 0000-0002-1758-9929 AD - Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - LaPorte, Zachary L AU - LaPorte ZL AD - Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Martin, Scott D AU - Martin SD AD - Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230915 PL - United States TA - Am J Sports Med JT - The American journal of sports medicine JID - 7609541 SB - IM MH - Humans MH - Adolescent MH - Adult MH - Hip Joint/diagnostic imaging/surgery MH - Cohort Studies MH - Retrospective Studies MH - Follow-Up Studies MH - Arthroscopy MH - Treatment Outcome MH - *Femoracetabular Impingement/diagnostic imaging/surgery MH - *Low Back Pain MH - Activities of Daily Living MH - Patient Reported Outcome Measures PMC - PMC10571439 OTO - NOTNLM OT - femoroacetabular impingement OT - hip arthroscopy OT - hip-spine syndrome OT - lumbosacral spine disease COIS- One or more of the authors has declared the following potential conflict of interest or source of funding: S.D.M. has received support for education from Kairos Surgical and a gift from Allergan. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. EDAT- 2023/09/16 10:43 MHDA- 2023/10/09 06:42 PMCR- 2023/10/13 CRDT- 2023/09/16 02:53 PHST- 2023/10/09 06:42 [medline] PHST- 2023/09/16 10:43 [pubmed] PHST- 2023/09/16 02:53 [entrez] PHST- 2023/10/13 00:00 [pmc-release] AID - 10.1177_03635465231197374 [pii] AID - 10.1177/03635465231197374 [doi] PST - ppublish SO - Am J Sports Med. 2023 Oct;51(12):3268-3279. doi: 10.1177/03635465231197374. Epub 2023 Sep 15.