The Outcome of Hip Arthroscopy in the Setting of Lumbar Spine Disease Is Beneficial, Yet Limited: A Systematic Review of Existing Evidence

Published:September 30, 2022DOI:


      To compare hip arthroscopy outcomes in femoroacetabular impingement (FAI) patients with concurrent symptomatic lumbar spine disease to the outcomes of arthroscopic FAI patients without spine disease.


      A systematic review was performed according to PRISMA guidelines via PubMed, Cochrane, Embase, and Google Scholar databases. Studies were valid for inclusion if they had an average follow-up ≥12 months and compared patient-reported outcome measures (PROMs) in hip arthroscopy patients with and without concurrent spinal disease. Data collected included study characteristics, patient demographics, follow-up intervals, surgical indications, spinal pathology, PROMs, and reoperation rates.


      Twelve studies were included in this systematic review. 3,107 patients who underwent hip arthroscopy were evaluated: 1,056 with coexisting lumbar spine disease (spine cohort) and 2,051 control subjects without spine disease (control cohort). The average follow-up period was 24 months. Across included studies, there were 35 instances wherein postoperative PROM scores reported by each cohort were compared. In all 35 instances, the spine cohort reported inferior postoperative PROM scores with the difference being significant (P < .05) on 23 PROMs. Collectively, 23 cases were available contrasting the proportion of each cohort to achieve the minimal clinically important difference (MCID). In 22 (95.65%) of these cases, the spine cohort achieved the MCID at a lower rate than the control cohort. There were 14 PROMs, wherein intragroup analyses were reported that compared the preoperative and postoperative score reported by the spine cohort. On all 14 PROMs, the spine cohort reported significant (P < .05) improvement after arthroscopic intervention.


      FAI patients with coexisting lumbar spine pathology experience significant improvement from baseline state after arthroscopic intervention. However, the postoperative outcomes reported are inferior, and the improvement from arthroscopy was limited when compared to surgical control subjects with FAI and normal spinal anatomy.

      Level of Evidence

      Level IV: systematic review of Level II, III, and IV studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Offierski C.M.
        • Macnab I.
        Hip-spine syndrome.
        Spine (Phila Pa 1976). 1983; 8: 316-321
        • Devin C.J.
        • McCullough K.A.
        • Morris B.J.
        • Yates A.J.
        • Kang J.D.
        Hip-spine syndrome.
        J Am Acad Orthop Surg. 2012; 20: 434-442
        • Redmond J.M.
        • Gupta A.
        • Hammarstedt J.E.
        • Stake C.E.
        • Domb B.G.
        The hip-spine syndrome: How does back pain impact the indications and outcomes of hip arthroscopy?.
        J Arthroscopy. 2014; 30: 872-881
        • Bischoff-Ferrari H.A.
        • Lingard E.A.
        • Losina E.
        • et al.
        Psychosocial and geriatric correlates of functional status after total hip replacement.
        Arthritis Rheum. 2004; 51: 829-835
        • Quintana J.M.
        • Escobar A.
        • Aguirre U.
        • Lafuente I.
        • Arenaza J.C.
        Predictors of health-related quality-of-life change after total hip arthroplasty.
        Clin Orthop Relat Res. 2009; 467: 2886-2894
        • Onggo J.R.
        • Nambiar M.
        • Onggo J.D.
        • et al.
        Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review.
        Eur Spine J. 2020; 29: 282-294
        • Lum Z.C.
        • Coury J.G.
        • Cohen J.L.
        • Dorr L.D.
        The current knowledge on spinopelvic mobility.
        J Arthroplasty. 2018; 33: 291-296
        • Lazennec J.-Y.
        • Brusson A.
        • Rousseau M.-A.
        Hip-spine relations and sagittal balance clinical consequences.
        Eur Spine J. 2011; 20: 686-698
        • Lazennec J.Y.
        • Charlot N.
        • Gorin M.
        • et al.
        Hip-spine relationship: a radio-anatomical study for optimization in acetabular cup positioning.
        Surg Radiol Anat. 2004; 26: 136-144
        • Lazennec J.Y.
        • Boyer P.
        • Gorin M.
        • Catonné Y.
        • Rousseau M.A.
        Acetabular anteversion with CT in supine, simulated standing, and sitting positions in a THA patient population.
        Clin Orthop Relat Res. 2011; 469: 1103-1109
        • Yang G.
        • Li Y.
        • Zhang H.
        The influence of pelvic tilt on the anteversion angle of the acetabular prosthesis.
        Orthop Surg. 2019; 11: 762
        • Blizzard D.J.
        • Nickel B.T.
        • Seyler T.M.
        • Bolognesi M.P.
        The impact of lumbar spine disease and deformity on total hip arthroplasty outcomes.
        Orthop Clin North Am. 2016; 47: 19-28
        • Rivière C.
        • Lazennec J.Y.
        • Van Der Straeten C.
        • Auvinet E.
        • Cobb J.
        • Muirhead-Allwood S.
        The influence of spine-hip relations on total hip replacement: A systematic review.
        Orthop Traumatol Surg Res. 2017; 103: 559-568
        • Fader R.R.
        • Tao M.A.
        • Gaudiani M.A.
        • et al.
        The role of lumbar lordosis and pelvic sagittal balance in femoroacetabular impingement.
        Bone Joint J. 2018; 100-B: 1275-1279
        • Heaps B.M.
        • Feingold J.D.
        • Swartwout E.
        • et al.
        Lumbosacral transitional vertebrae predict inferior patient-reported outcomes after hip arthroscopy.
        Am J Sports Med. 2020; 48: 3272-3279
        • Esposito C.I.
        • Miller T.T.
        • Kim H.J.
        • et al.
        Does degenerative lumbar spine disease influence femoroacetabular flexion in patients undergoing total hip arthroplasty?.
        Clin Orthop Relat Res. 2016; 474: 1788-1797
        • Feingold J.D.
        • Heaps B.
        • Turcan S.
        • Swartwout E.
        • Ranawat A.
        A history of spine surgery predicts a poor outcome after hip arthroscopy.
        J Hip Preserv Surg. 2019; 6: 227-233
        • Akpinar B.
        • Lin L.J.
        • Bloom D.A.
        • Youm T.
        Concomitant lumbar spinal stenosis negatively affects outcomes after hip arthroscopy for femoroacetabular impingement.
        J. Arthroscopy. 2021; 37: 2102-2109
        • Bozic K.J.
        • Chan V.
        • Valone F.H.
        • Feeley B.T.
        • Vail T.P.
        Trends in hip arthroscopy utilization in the United States.
        J Arthroplasty. 2013; 28: 140-143
        • Maradit Kremers H.
        • Schilz S.R.
        • Van Houten H.K.
        • et al.
        Trends in utilization and outcomes of hip arthroscopy in the United States between 2005 and 2013.
        J Arthroplasty. 2017; 32: 750-755
        • Lee Y.-K.
        • Ha Y.-C.
        • Yoon B.-H.
        • Koo K.-H.
        National trends of hip arthroscopy in Korea.
        J Korean Med Sci. 2014; 29: 277-280
        • Becker L.C.
        • Carter-Kelley S.
        • Ellis T.
        • Cenkus K.
        • Stasi SL Di
        Pre-operative low back pain negatively affects self-reported function in individuals undergoing hip arthroscopy.
        Int J Sports Phys Ther. 2015; 10: 992
        • Brown-Taylor L.
        • Bordner H.
        • Glaws K.
        • Vasileff W.K.
        • Walrod B.
        • Di Stasi S.
        Prevalence of low back pain and related disability in patients with femoroacetabular impingement syndrome.
        PM R. 2022; 14: 8-18
        • Clohisy J.C.
        • Baca G.
        • Beaulé P.E.
        • et al.
        Descriptive epidemiology of femoroacetabular impingement: A North American cohort of patients undergoing surgery.
        Am J Sports Med. 2013; 41: 1348-1356
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group T.P.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
        PLOS Med. 2009; 6e1000097
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement.
        J Clin Epidemiol. 2021; 134: 103-112
      1. Higgins J.P. Thomas J. Chandler J. Cochrane Handbook for Systematic Review of Interventions. 2nd ed. John Wiley & Sons, ew York2019
        • Von Elm E.
        • Poglia G.
        • Walder B.
        • Tramèr M.R.
        Different patterns of duplicate publication: An analysis of articles used in systematic reviews.
        JAMA. 2004; 291: 974-980
        • Wood J.
        Methodology for dealing with duplicate study effects in a meta-analysis.
        Organ Res Methods. 2008; 11: 79-95
        • Higgins J.P.T.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Cote M.P.
        • Lubowitz J.H.
        • Rossi M.J.
        • Brand J.C.
        Reviews pooling heterogeneous, low-evidence, high-bias data result in incorrect conclusions: But heterogeneity is an opportunity to explore.
        Arthroscopy. 2018; 34: 3126-3128
        • Øiestad B.E.
        • Engebretsen L.
        • Storheim K.
        • Risberg M.A.
        Knee osteoarthritis after anterior cruciate ligament injury: A systematic review.
        Am J Sports Med. 2009; 37: 1434-1443
        • Coleman B.D.
        • Khan K.M.
        • Maffulli N.
        • Cook J.L.
        • Wark J.D.
        Studies of surgical outcome after patellar tendinopathy: Clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group.
        Scand J Med Sci Sports. 2000; 10: 2-11
        • Beck E.C.
        • Nwachukwu B.U.
        • Chapman R.
        • Gowd A.K.
        • Waterman B.R.
        • Nho S.J.
        The influence of lumbosacral spine pathology on minimum 2-year outcome after hip arthroscopy: A nested case-control analysis.
        Am J Sports Med. 2020; 48: 403-408
        • Chandrasekaran S.
        • Darwish N.
        • Darwish A.H.
        • Suarez-Ahedo C.
        • Lodhia P.
        • Domb B.G.
        Outcomes of hip arthroscopy in patients with previous lumbar spine surgery: A matched-pair controlled comparative study with minimum two-year follow-up.
        Arthroscopy. 2019; 35: 443-450
        • Haskel J.D.
        • Baron S.L.
        • Zusmanovich M.
        • Youm T.
        Does concomitant lumbar spine disease adversely affect the outcomes of patients undergoing hip arthroscopy?.
        Am J Sports Med. 2020; 48: 2178-2184
        • Luo R.
        • Barsoum D.
        • Ashraf H.
        • et al.
        Prevalence of lumbosacral transitional vertebrae in patients with symptomatic femoroacetabular impingement requiring hip arthroscopy.
        Arthroscopy. 2021; 37: 149-155
        • Domb B.
        • Nasser R.
        • Finley Z.
        • Botser I.
        Patients with back pain have inferior results following hip arthroscopy: A minimum two-year follow-up match-paired study.
        Arthroscopy. 2014; 30: e21
        • Sun Y.
        • Thompson K.A.
        • Darden C.
        • Youm T.
        Surgical intervention for femoroacetabular impingement can lead to improvements in both hip and back function in patients with coexisting chronic back pain at 1-year follow-up.
        Arthroscopy. 2021; 37: 1163-1169.e1
        • Krishnamoorthy V.P.
        • Beck E.C.
        • Kunze K.N.
        • et al.
        Radiographic prevalence of sacroiliac joint abnormalities and clinical outcomes in patients with femoroacetabular impingement syndrome.
        Arthroscopy. 2019; 35: 2598-2605.e1
        • Leong N.L.
        • Clapp I.M.
        • Neal W.H.
        • Beck E.
        • Bush-Joseph C.A.
        • Nho S.J.
        The influence of pain in other major joints and the spine on 2-year outcomes after hip arthroscopy.
        Arthroscopy. 2018; 34: 3196-3201
        • Byrd J.W.T.
        Hip arthroscopy: patient assessment and indications.
        Instr Course Lect. 2003; 52: 711-719
        • Martin R.R.L.
        • Kelly B.T.
        • Philippon M.J.
        Evidence of validity for the hip outcome score.
        J Arthroscopy. 2006; 22: 1304-1311
        • Martin R.R.L.
        • Philippon M.J.
        Evidence of validity for the hip outcome score in hip arthroscopy.
        J. Arthroscopy. 2007; 23: 822-826
        • Christensen C.P.
        • Althausen P.L.
        • Mittleman M.A.
        • Lee J ann
        • McCarthy J.C.
        The nonarthritic hip score: reliable and validated.
        Clin Orthop Relat Res. 2003; : 75-83
        • Nwachukwu B.U.
        • Chang B.
        • Beck E.C.
        • et al.
        How should we define clinically significant outcome improvement on the iHOT-12?.
        HSS J. 2019; 15: 103-108
        • Haskel J.D.
        • Baron S.L.
        • Zusmanovich M.
        • Youm T.
        Does concomitant lumbar spine disease adversely affect the outcomes of patients undergoing hip arthroscopy?.
        Am J Sports Med. 2020; 48: 2178-2184
        • Ben-Galim P.
        • Ben-Galim T.
        • Rand N.
        • et al.
        Hip-spine syndrome: The effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip.
        Spine (Phila Pa 1976). 2007; 32: 2099-2102
        • Parvizi J.
        • Pour A.E.
        • Hillibrand A.
        • Goldberg G.
        • Sharkey P.F.
        • Rothman R.H.
        Back pain and total hip arthroplasty: a prospective natural history study.
        Clin Orthop Relat Res. 2010; 468: 1325-1330
        • Prather H.
        • Van Dillen L.R.
        • Kymes S.M.
        • Armbrecht M.A.
        • Stwalley D.
        • Clohisy J.C.
        Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty.
        Spine J. 2012; 12: 363-369
        • Vrtovec T.
        • Janssen M.M.A.
        • Likar B.
        • Castelein R.M.
        • Viergever M.A.
        • Pernuš F.
        A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment.
        Spine J. 2012; 12: 433-446
        • Moley P.J.
        • Gribbin C.K.
        • Vargas E.
        • Kelly B.T.
        Co-diagnoses of spondylolysis and femoroacetabular impingement: a case series of adolescent athletes.
        J Hip Preserv Surg. 2018; 5: 393
        • Domb B.G.
        • Shindle M.K.
        • McArthur B.
        • Voos J.E.
        • Magennis E.M.
        • Kelly B.T.
        Iliopsoas impingement: A newly identified cause of labral pathology in the hip.
        HSS J. 2011; 7: 145
        • Bedi A.
        • Kelly B.T.
        • Khanduja V.
        Arthroscopic hip preservation surgery: Current concepts and perspective.
        Bone Joint J. 2013; 95-B: 10-19
        • Bedi A.
        • Dolan M.
        • Hetsroni I.
        • et al.
        Surgical treatment of femoroacetabular impingement improves hip kinematics: A computer-assisted model.
        Am J Sports Med. 2011; 39 (1_suppl): 43S-49S
        • Roussouly P.
        • Pinheiro-Franco J.L.
        Biomechanical analysis of the spino-pelvic organization and adaptation in pathology.
        Eur Spine J. 2011; 20 (Suppl 5): 609-618
        • Rivière C.
        • Hardijzer A.
        • Lazennec J.Y.
        • Beaulé P.
        • Muirhead-Allwood S.
        • Cobb J.
        Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review.
        Orthop Traumatol Surg Res. 2017; 103: 549-557
        • Lazennec J.Y.
        • Clark I.C.
        • Folinais D.
        • Tahar I.N.
        • Pour A.E.
        What is the impact of a spinal fusion on acetabular implant orientation in functional standing and sitting positions?.
        J Arthroplasty. 2017; 32: 3184-3190
        • Koppenhaver S.
        • Gaffney E.
        • Oates A.
        • et al.
        Lumbar muscle stiffness is different in individuals with low back pain than asymptomatic controls and is associated with pain and disability, but not common physical examination findings.
        Musculoskelet Sci Pract. 2020; 48: 2178-2184
        • Hart R.A.
        • Marshall L.M.
        • Hiratzka S.L.
        • Kane M.S.
        • Volpi J.
        • Hiratzka J.R.
        Functional limitations due to stiffness as a collateral impact of instrumented arthrodesis of the lumbar spine.
        Spine (Phila Pa 1976). 2014; 39: E1468-E1474
        • Kimura H.
        • Fujibayashi S.
        • Otsuki B.
        • Takahashi Y.
        • Nakayama T.
        • Matsuda S.
        Effects of lumbar stiffness after lumbar fusion surgery on activities of daily living.
        Spine (Phila Pa 1976). 2016; 41: 719-727
        • Ranawat C.S.
        • Ranawat A.S.
        • Lipman J.D.
        • White P.B.
        • Meftah M.
        Effect of spinal deformity on pelvic orientation from standing to sitting position.
        J Arthroplasty. 2016; 31: 1222-1227
        • Stefl M.
        • Lundergan W.
        • Heckmann N.
        • et al.
        Spinopelvic mobility and acetabular component position for total hip arthroplasty.
        Bone Joint J. 2017; 99-B: 37-45
        • Buckland A.J.
        • Vigdorchik J.
        • Schwab F.J.
        • et al.
        Acetabular anteversion changes due to spinal deformity correction: Bridging the gap between hip and spine surgeons.
        J Bone Joint Surg Am. 2015; 97: 1913-1920
        • Gagnier J.J.
        • Moher D.
        • Boon H.
        • Beyene J.
        • Bombardier C.
        Investigating clinical heterogeneity in systematic reviews: A methodologic review of guidance in the literature.
        BMC Med Res Methodol. 2012; 12: 111