Back Pain Prior To Hip Arthroscopy For Femoroacetabular Impingement Predicts Inferior Results

TitleBack Pain Prior To Hip Arthroscopy For Femoroacetabular Impingement Predicts Inferior Results
Publication TypeConference Paper
Year of Publication2011
AuthorsPaik RS, Botser I B, Nasser R M, Domb BG
Conference NameInternational Society of Hip Arthroscopy (ISHA)
Date Published10/2011
Conference LocationParis, France
Abstract

Summary: FAI patients with and without a history of back pain improve significantly after arthroscopic treatment. Although those with back pain have equivalent relative improvement, their absolute clinical results and satisfaction are inferior compared to patients without back pain. Hence, the patients’ and surgeon’s expectations for FAI surgery should be adjusted accordingly when back pain is present.

Objectives:
The hip and the spine are intimately related anatomically and functionally, and their respective disorders may present with overlapping symptomatology. A problem in one area could potentially cause or aggravate problems in the other. The hypothesis of this study was that hip surgery for femoro-acetabular impingement (FAI) would have inferior results in patients with a history of low back pain.

Methods:
Between February 2008 and April 2010, data was prospectively collected for all patients undergoing arthroscopic surgery for FAI. Exclusion criteria were previous surgery on the same hip other than diagnostic hip arthroscopy, Tonnis arthritic grade 2 or 3, and previous hip condition such as AVN, LCPD, or DDH. Any history of back pain was recorded and the type of pain and duration were noted. A total of 116 hips (112 patients) met the inclusion/exclusion criteria. Ninety-one patients had no history of back pain, while 25 had a positive history of back pain. Radiographic and intraoperative findings and procedures were recorded. All patients were assessed pre- and post-operatively using the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS), and the visual analog pain scale (VAS). Post-operatively, patients were asked for their satisfaction from the surgery on a scale from 0 to 10.

Results:
There was no difference in the radiographic findings pre- and post-operatively, or the intra-operative findings and procedures between the two groups. Pre-operative clinical scores (mHHS and NASH) trended lower for the back pain group; pain level (VAS) was similar between the groups. At mean follow-up of 15 months (11 to 30 months), all scores were significantly improved, and there was no difference in relative improvement between patients with or without back pain. However, the absolute clinical scores (mHHS and NASH) were lower for the back pain group (p=0.05 and 0.06, respectively); the pain level (VAS) trended lower as well (p=0.07). Moreover, patients with back pain were significantly less satisfied with the result of the surgery (p=0.02).

Conclusions:
FAI patients with and without a history of back pain improve significantly after arthroscopic treatment. Although those with back pain have equivalent relative improvement, their absolute clinical results and satisfaction are inferior compared to patients without back pain. Hence, the patients’ and surgeon’s expectations for FAI surgery should be adjusted accordingly when back pain is present.

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