The hip-spine syndrome: how does back pain impact the indications and outcomes of hip arthroscopy?

PURPOSE Many patients presenting with hip disease also have coexisting lumbar spine disease (LSD). At present there is a paucity of literature examining the effect of arthroscopic hip surgery in patients with coexisting LSD. The purpose of this systematic review was to examine the relationship between the hip and lumbar spine to determine whether low back pain impacts the indications and outcomes for surgical intervention of the hip. METHODS A systematic review of the literature was performed by a search of PubMed using the following search terms: (1) hip, back, and motion; (2) hip, back, and pain; and (3) hip, lumbar spine, and pain. Two reviewers searched for relevant articles that met established inclusion criteria. We excluded review articles, technique articles, articles reporting on the same patient population, and articles without reported patient data. Kinematic data pertaining to the hip for patients with low back pain was collected. Preoperative and postoperative data were collected for patients treated for hip disease in the setting of LSD. RESULTS After examining 2,020 references and abstracts, 15 articles were selected for this review. Patients with low back pain consistently demonstrated decreased hip range of motion compared with controls. Patients undergoing hip surgery with coexisting LSD showed improvement in the modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Visual Analog Scale (VAS), SF-36 scores, and the Owestry Disability Index. CONCLUSIONS Patients with low back pain frequently have limited or altered hip range of motion, and these patients routinely improve after surgical intervention for hip disease. Surgical intervention for hip disease should be considered in the context of low back pain and LSD. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.