To compare clinical outcomes at 2 years following primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) between patients with and without low-grade lumbosacral transitional vertebra (LSTV).
We performed a retrospective matched-cohort analysis of patients who underwent primary HA for FAIS from 2011 to 2018 with minimum 2-year follow-up. LSTV was graded on preoperative radiographs using the Castellvi classification. Patients with grades I and II LSTV were matched 1:1 with controls on age, sex, and body mass index. Radiographic markers of FAIS morphology were measured. Pre- to postoperative improvement in the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) as well as 2-year achievement rates for the minimum clinically-important difference, substantial clinical benefit, and patient acceptable symptom state were compared between patients with versus without LSTV. The Wilcoxon signed-rank test was used for intergroup mean comparisons and the Cochran–Mantel–Haenszel test for categorical variables.
In total, 58 patients with LSTV were matched to 58 controls. Among LSTV patients, 48 were Castellvi type 1 (82.8%) and 32 (55.2%) had bilateral findings. No significant differences were found between groups with respect to radiographic markers of FAIS, including alpha angle (P = .88), lateral center edge angle (P = .42), or crossover sign (P = .71). Although patients with LSTV had greater improvement in NAHS at 2-year follow-up compared with control patients (P = .04), there were no significant differences in modified Harris Hip Score improvement (P = .31) or achievement of the minimum clinically-important difference (P = .73), substantial clinical benefit (P = .61), or patient acceptable symptom state (P = .16).
Patients with low-grade LSTV had greater 2-year improvement in NAHS than controls, whereas no significant differences were observed in achievement of clinical thresholds at 2-year follow-up. There were no differences between groups with respect to any measured radiographic markers of FAIS morphology. Importantly, the findings of this study are underpowered and should be viewed with caution in the greater context of the LSTV literature.
Level of Evidence
III; retrospective comparative study.
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- Survivorship and outcome of hip arthroscopy for femoroacetabular impingement syndrome performed with modern surgical techniques.Am J Sports Med. 2019; 47: 1662-1669
- Spinopelvic motion and impingement in total hip arthroplasty.J Arthroplasty. 2019; 34: S53-S56
- Sagittal morphology and equilibrium of pelvis and spine.Eur Spine J. 2002; 11: 80-87
- Acetabular labral tear is associated with high pelvic incidence with or without femoroacetabular impingement morphology.Knee Surg Sports Traumatol Arthrosc. 2022; 30: 3526-3534
- Bertolotti’s syndrome revisited. Transitional vertebrae of the lumbar spine.Spine (Phila Pa 1976). 1989; 14: 1373-1377
- The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome: A cross-sectional evaluation of a prospective hip registry cohort.Bone Joint J. 2021; 103-B: 1351-1357
- Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects.Spine (Phila Pa 1976). 1984; 9: 493-495
- The transitional vertebra of the lumbosacral spine: Its radiological classification, incidence, prevalence, and clinical significance.Rheumatol Rehabil. 1977; 16: 180-185
- Lumbosacral transitional vertebrae and nerve-root symptoms.J Bone Joint Surg Br. 2001; 83: 1137-1140
- Lumbosacral transitional vertebra: Relation to disc degeneration and low back pain.Spine (Phila Pa 1976). 2004; 29: 200-205
- Lumbosacral transitional vertebrae: Incidence in a consecutive patient series.Pain Physician. 2006; 9: 53-56
- Prevalence of lumbosacral transitional vertebrae in patients with symptomatic femoroacetabular impingement requiring hip arthroscopy.Arthroscopy. 2021; 37: 149-155
- Lumbosacral transitional vertebra in a population-based study of 5860 individuals: Prevalence and relationship to low back pain.Eur J Radiol. 2014; 83: 1679-1682
- Numeric and morphological verification of lumbosacral segments in 8280 consecutive patients.Spine (Phila Pa 1976). 2013; 38: E573
- Lumbar fusion involving the sacrum increases dislocation risk in primary total hip arthroplasty.Bone Joint J. 2019; 101-B: 198-206
- Lumbosacral transitional vertebrae predict inferior patient-reported outcomes after hip arthroscopy.Am J Sports Med. 2020; 48: 3272-3279
- Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery.Am J Sports Med. 2013; 41: 2065-2073
- The minimal clinically important difference for the nonarthritic hip score at 2-years following hip arthroscopy.Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2022; 30: 2419-2423
- Determining clinically meaningful thresholds for the nonarthritic hip score in patients undergoing arthroscopy for femoroacetabular impingement syndrome.Arthroscopy. 2021; 37: 3113-3121
- Preoperative outcome scores are predictive of achieving the minimal clinically important difference after arthroscopic treatment of femoroacetabular impingement.Am J Sports Med. 2017; 45: 612-619
- The Patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.Am J Sports Med. 2015; 43: 1844-1849
- Defining the “substantial clinical benefit” after arthroscopic treatment of femoroacetabular impingement.Am J Sports Med. 2017; 45: 1297-1303
- Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: A systematic review.Arthroscopy. 2015; 31: 1199-1204
- The bipolar hip: How acetabular and femoral pathomorphology affects hip motion in femoral acetabular impingement syndrome.Arthroscopy. 2020; 36: 1864-1871
- Pelvic posture and kinematics in femoroacetabular impingement: A systematic review.J Orthop Traumatol. 2017; 18: 187-196
- The current knowledge on spinopelvic mobility.J Arthroplasty. 2018; 33: 291-296
- The influence of pelvic tilt on acetabular orientation and cover: A three-dimensional computerised tomography analysis.Hip Int. 2013; 23: 87-92
- Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation.J Arthroplasty. 2018; 33: 1449-1454
- Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion.Bone Joint J. 2017; 99-B: 585-591
- The role of lumbar lordosis and pelvic sagittal balance in femoroacetabular impingement.Bone Joint J. 2018; 100-B: 1275-1279
- Editorial Commentary: Lumbosacral anatomy and mechanics influence femoroacetabular impingement syndrome and surgical outcomes: The hip bone is connected to the back bone.Arthroscopy. 2021; 37: 156-158
- The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.J Bone Joint Surg Br. 2002; 84: 556-560
- Ischial spine projection into the pelvis: A new sign for acetabular retroversion.Clin Orthop. 2008; 466: 677-683
- The ischial spine sign: Does pelvic tilt and rotation matter?.Clin Orthop. 2010; 468: 769-774
- Center edge angle measurement for hip preservation surgery: technique and caveats.Orthopedics. 2011; 34: 86
- Retroversion of the acetabulum. A cause of hip pain.J Bone Joint Surg Br. 1999; 81: 281-288
- Imaging evaluation of developmental hip dysplasia in the young adult.AJR Am J Roentgenol. 2013; 200: 1077-1088
- Recognition of minor adult hip dysplasia: Which anatomical indices are important?.Hip Int. 2014; 24: 175-179
- Femoroacetabular impingement predisposes to traumatic posterior hip dislocation.Clin Orthop. 2013; 471: 1937-1943
- Presence of a posterior wall sign in the treatment of femoroacetabular impingement syndrome: A matched comparative cohort analysis at minimum 2-year follow-Up.J Arthroplasty. 2022; 37: 1520-1525
- Early outcomes of primary total hip arthroplasty after prior lumbar spinal fusion.J Arthroplasty. 2017; 32: 470-474
- Correlation of obesity with patient-reported outcomes and complications after hip arthroscopy.Arthroscopy. 2015; 31: 57-62
- Predictors of clinical outcomes after hip arthroscopy: A prospective analysis of 1038 patients with 2-year follow-up.Am J Sports Med. 2018; 46: 1324-1330
Published online: February 10, 2023
Accepted: January 25, 2023
Received: August 8, 2022
Publication stageIn Press Journal Pre-Proof
The authors report the following potential conflicts of interest or sources of funding: T.Y. reports personal fees from Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
© 2023 by the Arthroscopy Association of North America