Outcomes of Hip Arthroscopy Patients with Concomitant Lumbosacral Spinal Pathology compared to a Matched Control Cohort at Five-Year Follow-Up.

Background: Patients with hip and lumbosacral spinal pathologies may experience exacerbated symptoms as a result of these concomitant conditions. There is a paucity of midterm follow-up on patients who undergo primary hip arthroscopy before spinal surgery. Purpose: To assess patient-reported outcome measures (PROMs) among patients with hip arthroscopy and concomitant symptomatic lumbosacral pathology at 5-year follow-up and to compare revision rates and conversion to total hip arthroplasty between patients in a hip-spine (HS) cohort and patients in a matched control (MC) cohort without lumbosacral pathology. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective review analyzed prospective data of patients who underwent primary hip arthroscopy for treatment of symptomatic labral tears. The study included patients aged ≥18 years with PROMs at baseline and minimum 60-month follow-up. Patients with HS syndrome were propensity matched to a MC group without any lumbosacral pathologies. Patients in the HS cohort indicated (1) lower back pain/symptoms on preoperative surveys, (2) a pathologic lumbosacral spine diagnosis confirmed by a radiologist, and (3) clinical documentation. PROMs, clinically meaningful outcomes, improvement over time, revision rates, and conversion to total hip arthroplasty were compared. Results: A total of 76 patients were included, with 38 patients each in the HS and MC cohorts. The HS cohort had significantly worse functional outcomes at baseline and 12-, 24-, and 60-month follow-up. However, the HS cohort demonstrated no significant difference in achieving the minimal clinically important difference, Patient Acceptable Symptom State, and substantial clinical benefit but showed a mix of no significant difference or significantly greater mean magnitudes of improvement across various PROMs over time. There were no significant differences in rates of revision or conversion to total hip arthroplasty. Conclusion: Although hip arthroscopy patients with concomitant lumbosacral spinal pathology report lower functional outcomes at 5 years than MCs, they can expect similar, if not higher, magnitudes of improvement, as well as similar rates of achieving clinically meaningful outcomes and no increased risk of secondary surgery. These findings substantiate that HS pathology is not an absolute contraindication for hip arthroscopy.