Jacob E. Milner

Purpose This study compares PROMs between patients who underwent hip arthroscopy prior to hip resurfacing arthroplasty (HRA) to a matched cohort of HRA patients without prior arthroscopy. Methods A retrospective cohort study was performed of patients who underwent a HRA from 2016 to 2021 with minimum 2-year follow-up. Patients with prior arthroscopy were matched 1:3 with controls on age, sex, BMI, and ASA classification. Subjects completed HOOS JR, FJS, SANE, and PROMIS for physical function, pain intensity, and pain interference. The Mann-Whitney U test was used for intergroup mean comparisons and Fisher’s exact test for categorical variables. Results 20 patients with prior hip arthroscopy were matched to 60 controls (mean age: 47.1 ± 7.2 years; BMI: 29.5 ± 4.2, 96% male). Patients who underwent hip arthroscopy prior to HRA reported significantly greater pain (33.8 vs. 13.2, p = 0.011), poorer FJS (46.6 vs. 70.5, p = 0.030), physical function (43.7 vs. 50.9, p = 0.018), SANE rating (59.9 vs. 82.6, p = 0.005), and satisfaction (66.1 vs. 88.1, p = 0.006) after HRA. 11 patients (55.0%) stated that their hip resurfacing procedure met their expectations compared to 52 patients (86.7%) in the control group. Conclusions Patients who underwent hip arthroscopy prior to HRA have an association with significantly worse patient-reported outcome metrics, poor postoperative satisfaction, and higher postoperative pain.

Purpose Though Femoroacetabular impingement (FAI) is thought of as primarily a hip condition an increasing body of evidence has demonstrated the existence of a relationship between the hip joint and lumbopelvic spine, termed the hip-spine syndrome (HSS). This review will provide an overview of the relevant pelvic parameters, proper HSS patient evaluation, describe how lumbar pathology may mechanistically affect the hip, provide a literature review of biomechanic and outcome papers exploring the subject, and finally investigate potential interventions that can be considered in these challenging patients. Recent Findings Deviations from normal ranges in pelvic parameters have been shown in biomechanical studies to worsen FAI by decreasing the range of impingement free motion. The clinical relevance of this is still being determined. Patients with concomitant lumbar spine pathology may significantly improve after hip arthroscopy, though they may have a lower ceiling than comparable patients without lumbar spine pathology. Summary Surgeons and patients should be aware of the HSS. Alterations in pelvic parameters may affect outcomes, though this still has to be determined. Patients with lumbar spine pathology and FAI can still be treated successfully with hip arthroscopy, though should be counseled appropriately.