The London Spine Unit : finest day surgery unit on Harley Street UK
While net PROs from baseline improve after hip arthroscopy for FAI, the presence of concomitant lumbar spinal stenosis negatively affects post-operative PROs. FAI patients with spinal stenosis should be counseled accordingly.Lumbar Disc Replacement Expert. Best Spinal Surgeon UK
Purpose: The purpose of this study was to assess the prognostic effect of lumbar spinal stenosis on clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAI).
Methods: Patients undergoing hip arthroscopy between September 2009 to December 2015 for FAI with concomitant lumbar spinal stenosis (central/neuroforaminal) and a 2-year follow-up were identified (hip-spine). A 1:1 case-matching query using pre-operative modified Harris Hip Score (mHHS) within 3 points, body mass index (BMI) within 3 points, age within 5 years, and gender identified a control cohort without spinal pathology. Follow-up patient reported outcomes and clinical failure rates to revision procedure were compared using analysis of variance (ANOVA) and Kaplan-Meier survival analysis.
Results: Twenty-six patients met criteria of the hip-spine group (age: 45.9±12.2 years; BMI: 27.3±5.0 kg/m2, baseline mHHS: 44.17±2.76) versus the control group (age: 46.2±12.4 years, P=0.94; BMI: 26.7±4.1 kg/m2, P=0.61; baseline mHHS: 44.27±2.82, P=0.98). ANOVA analysis demonstrated that all PROs improved from baseline to 2-year outcomes (P<0.001). The hip-spine versus control had lower 1-year (mHHS: 65.97±5.64 versus 85.04±3.09, P=0.006; nonarthritic hip score (NAHS): 70.26±5.71 versus 87.89±2.65, P=0.010) and 2-year (mHHS: 69.72±4.92 versus 84.71±2.56, P=0.007; NAHS: 72.23±5.18 versus 87.14±2.23, P=0.008) outcomes. While there was no difference in Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) rates at 1-year follow-up, the hip-spine group demonstrated lower PASS (42% versus 81%, P =0.004) and MCID (58% versus 88%, P=0.027) rates at 2 years. Although susceptible to type II error, there was no difference in clinical failure rates to revision procedure (P=0.13).
While net PROs from baseline improve after hip arthroscopy for FAI, the presence of concomitant lumbar spinal stenosis negatively affects post-operative PROs. FAI patients with spinal stenosis should be counseled accordingly.
Level of evidence: III, case-control study.
Keywords: femoroacetabular impingement; hip arthroscopy; hip-spine syndrome; lumbar spine stenosis.
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