Summary

A systematic review of concomitant hip arthroscopy with low back pathology.

Abstract

Background

There is a paucity of literature reporting on the effect of low back pathology on outcomes after primary hip arthroscopy.

Purpose

To review outcomes of patients with low back pathology after undergoing primary hip arthroscopy for the treatment of FAIS.

Methods

PubMed, Cochrane, and Scopus were queried in June 2022 to conduct this systematic review using the following keywords, “hip,” “femoroacetabular impingement,” “arthroscopy,” “arthroscopic,” “spine,” “lumbar,” “sacral,” “hip-spine,” “back,” and “outcomes.” Articles were included if they reported on outcomes of patients undergoing hip arthroscopy with concurrent low back pathology. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Case reports, opinion articles, review articles, and technique articles were excluded from this study. Demographic characteristics, radiographic measurements, intraoperative findings, surgical procedures, and clinical outcomes were recorded when available.

Results

Twelve studies met the inclusion criteria. Two studies were level II, 9 studies were level III and 1 study was level IV. There were 521 hips with low back pathology and FAI (hip-spine syndrome) and 1,030 hips only had FAI (no hip-spine syndrome). All twelve studies reported patient-reported outcomes (PROs) and 10 of the studies reported psychometric thresholds. Three studies in the hip-spine group and seven studies in the FAI group reported their respective cohorts achieving the minimal clinically important difference (MCID) at a rate of 80% in at least one PRO. Rates of secondary arthroscopy for hip-spine syndrome and FAI without low back pathology groups ranged from 3% - 27% and 2% - 10.3%, respectively. The rates of undergoing THA for hip-spine syndrome and FAI without low back pathology ranged from 0% - 21% and 0% - 10%, respectively. Seven studies reported that low back pathology was associated with inferior outcomes or clinical benefit.

Conclusion

Patients undergoing primary hip arthroscopy with low back pathology can expect favorable outcomes. However, there was variability between low back pathology diagnosis and outcomes. Further studies are needed to isolate for specific low back conditions to determine their effect on outcomes after primary hip arthroscopy.