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.
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.
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
For more information:
- 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.
- Benjamin G. Domb, MD, can be reached at Hinsdale Orthopaedics
Associates, 1010 Executive Ct., Suite 250, Westmont, IL; 630-455-7130; email:
- Disclosure: Domb and colleagues have no relevant financial