Hip Spine Syndrome Negatively Impacts Arthroscopic Outcomes in the Management of Femoroacetabular Impingement Syndrome: A Systematic Review

To determine whether the presence of spine pathology affects clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in the setting of hip-spine syndrome (HSS) A systematic review of PubMed and Cochrane was conducted. Primary research articles evaluating patient-reported outcomes (PRO) after hip arthroscopy for FAIS in the presence of concomitant spine pathology were considered Literature review identified 12 studies meeting criteria. In 2109 FAIS patients undergoing hip arthroscopy, 591 had concomitant spine pathology. Baseline PROs in the hip-spine (modified Harris Hip Score [mHHS]: 39.8–65.29 vs 56.9–78.8, 8 studies; non-arthritic hip score [NAHS]: 42.2–51.5 vs 68.2–75.2, 4 studies; hip outcome score-activities of daily living [HOS-ADL]: 45.9–71.1 vs 49.3–89.51, 9 studies; hip outcome score-Sport (HOS-Sport): 22.8–49.6 vs 50.6–73.1, 3 studies; international hip outcome tool-33 [iHOT-12]: 38.0 vs 66.0, 1 study; visual analog scale [VAS] Pain: 6.43–6.56 vs 1.18–3.60, 3 studies; VAS Satisfaction: 7.18–7.46 range at follow-up, 2 studies) and control (mHHS: 39.3–64.9 vs 70.2–92.6, 6 studies; NAHS: 42.8–54.2 vs 74.0–87.1, 4 studies; HOS-ADL: 59.0–76.4 vs 75.4–97.1, 4 studies; HOS-Sport: 38.1–55.1 vs 60.9–93.9, 3 studies; iHOT-12: 43.4 vs 89.8, 1 study; VAS Pain: 6.18–6.22 vs 1.82–3.44, 2 studies; VAS Satisfaction: 7.74–8.22 range at follow up, 2 studies). Minimal clinically important difference threshold rates achieved in the hip-spine (44.1–86.7, 4 studies) cohorts were significantly lower than control (79.4–88.2%; 4 studies) cohorts in 3 studies. Patient-acceptable symptomatic state threshold rates achieved in the hip-spine (42–63.5, 3 studies) cohorts were significantly lower than control (58.8–81.0, 3 studies) in 1 study. There was no statistical difference in complication and reoperation rates between cohorts FAIS patients with concomitant HSS have improved but inferior outcomes after hip arthroscopy compared to patients without HSS IV, systematic review.