The Effect of Previous Lumbar Spine Surgery on Primary Hip Arthroscopic Surgery: A Minimum 5-Year Follow-up.
Authors
Quesada-Jimenez R, Schab AR, Kahana-Rojkind AH, Walsh EG, Domb BG
Background
Prior lumbar spine surgery (LSS) may alter spinal-pelvic mechanics, increasing stress and demand on the hip joint. This study evaluates how a history of LSS impacts long-term outcomes after primary hip arthroscopic surgery.
Methods
This retrospective case-control study analyzed 424 hips: 106 from patients with prior LSS and 318 from matched controls without LSS. All patients underwent hip arthroscopy and had a minimum 5-year follow-up. Matching was done in a 1:3 ratio based on age, sex, BMI, and acetabular Outerbridge grade. Patient-reported outcomes (PROs) included modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score–Sports Specific Subscale (HOS-SSS). Rates of clinically relevant thresholds, complications, revision surgeries, and conversion to total hip arthroplasty (THA) were also compared.
Key Findings
- Both groups experienced significant improvement in PRO scores.
- The LSS group began with lower preoperative scores but improved at similar rates to the control group.
- Despite comparable improvement, the LSS group had lower absolute postoperative PRO scores.
- Fewer LSS patients reached the Patient Acceptable Symptom State (PASS) for mHHS, NAHS, and HOS-SSS.
- No difference in complication or revision surgery rates.
- The LSS group converted to THA significantly sooner (27.4 vs. 48.0 months; p < 0.05).
Conclusion
Patients with prior LSS can achieve significant functional improvement after hip arthroscopy, comparable in magnitude to those without LSS. However, they report lower postoperative scores, are less likely to meet clinical symptom thresholds, and tend to progress to total hip arthroplasty sooner.
What Does This Mean For Patients
Having a history of back surgery does not prevent meaningful improvement after hip arthroscopy. However, these patients may not reach the same level of symptom relief as others and may require a hip replacement earlier. Setting realistic expectations and close monitoring is important in this group.