American Academy of Orthopaedic Surgeons Annual Meeting

American Academy of Orthopaedic Surgeons Annual Meeting

Issue: Issue 4 2012
Perspective from A. Mazhar Tokgozoglu, MD
Perspective from Dean K. Matsuda, MD
April 13, 2012
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Study links history of back pain to poorer results after hip arthroscopy for FAI

Issue: Issue 4 2012
Perspective from A. Mazhar Tokgozoglu, MD
Perspective from Dean K. Matsuda, MD
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Although a comparison of patients with and without a history of low back pain showed significant improvements in both groups more than 1 year following hip arthroscopy for femoroacetabular impingement, researchers from Chicago discovered lower absolute clinical scores in the back pain group.

“This study shows that back pain prior to hip arthroscopy for femoroacetabular impingement actually predicts inferior results,” Benjamin G. Domb, MD, said regarding the study, which was presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.

Study cohorts

 a patient who underwent spinal fusion and has a cam lesion on both hips
This AP radiograph shows a patient who underwent spinal fusion and has a cam lesion on both hips.

Image: Boster I

Domb and his colleagues Itamar Botser, MD, Ronald Paik, MD, and Rima Nasser, MD, studied 114 patients — 89 cases without back pain and 25 cases with a history of back pain — who had at least 1-year follow-up after undergoing arthroscopic surgery for femoroacetabular impingement (FAI). The researchers noted the history, severity and duration of back pain in each case. They excluded from the study patients with a high Tonnis grade, a history of revision or previous hip conditions, such as developmental dysplasia of the hip, avascular necrosis and Legg-Calve-Perthes Disease.

Outcome measures for the study included the Non-arthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS) and patient satisfaction measured on a 10-point scale.

A comparison of the groups revealed no significant differences in age, gender, follow-up time or how many months patients showed back pain symptoms prior to surgery, Botser said. Labral tear size, Tonnis grade and the number of anchors used were also similar between groups. In addition radiographic findings preoperatively and postoperatively showed no significant differences between groups, according to the study abstract.

The investigators found that patients with a history of back pain had less pain and lower NAHS and mHHS results than those without back pain, but these differences were not statistically significant.

Absolute differences

At 15-month follow-up both groups improved significantly for all outcome measures and there was no difference in the relative improvement between the groups. However, investigators found that absolute mHHS and NAHS outcomes were significantly lower in the back pain group than those without back pain. They also discovered that patients without a history of back pain were significantly more satisfied with the surgery.

“FAI patients with a history of back pain improved significantly after the surgery,” Domb said. “However, their clinical results and satisfaction are inferior to patients without back pain. We believe that both the patient and the surgeon’s expectations should be adjusted accordingly.” – by Jeff Craven

Reference:
  • Botser I, Nasser R, Domb B. Back pain prior to hip arthroscopy for femoroacetabular impingement predicts inferior results. Paper # 662. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
For more information:
  • Benjamin G. Domb, MD, can be reached at Hinsdale Orthopaedics Associates, 1010 Executive Ct., Suite 250, Westmont, IL; 630-455-7130; email: dombsteam@gmail.com.
  • Disclosure: Domb and colleagues have no relevant financial disclosures.