The hip-spine syndrome has been recognized for several years, but recently, more aspects of the condition have been appreciated. Particularly, as orthopaedic surgeons perform more total hip replacement or spine surgeries on an increasing number of patients, and there is an increasing demand for return to function in active, elderly cases, we regularly face troublesome cases that affect the hip and spine. For example, we may encounter cases where spine surgery for lower lumbar degenerative disease or THR either did not relieve any of a patient’s pain in the hip region, as expected, or it did not sufficiently relieve all the patient’s pain.
Larger studies have shown that about 5% to 10% of patients who undergo THR to treat radiographically and clinically proven coxarthrosis are still in pain 1 year after surgery. The same situation with a greater percent of patients who are still in pain postoperatively has been reported following surgical treatment of lower lumbar degenerative diseases. For our patients, this is a frustrating situation. When surgical treatment of recognized degenerative diseases in either the hip or lumbar spine leads to no relief or only insignificant relief of “hip pain,” this makes these procedures a failure from the patient’s viewpoint.
Therefore, more focus on this area is needed to confirm and examine both hip and spine degenerative in a standard way in all individuals who present to the outpatient clinic with pain in “the hip region.” Standard clinical and radiographic examinations should be performed to clarify both aspects of this condition. An optimal situation would be if all questionable cases were examined at the same time by a hip surgeon, as well as a spine surgeon, to confirm the severity of the two sites of degenerative disease and to discuss with patients the risks and benefits of THR and/or spine surgery.
I have had good experience in this area due to a close relationship our team members have when in the assessment of these cases to determine if the index surgery should be for the hip or spine. Patients are often confused in this situation because they say they are only having a significant hip problem and, therefore, they frequently question the team’s conclusions. We have found it is important to have performed the combined examination, have informed the patient on all aspects of the examination and to have the findings documented in the patient record.
Our overall aim is to develop patients who are highly informed, satisfied and safely treated patients. Subsequent discussion will be easier when patients ask why they are not pain-free after surgery.
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- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Rd., Thorofare, NJ 08086, USA; email: firstname.lastname@example.org.
Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.