In a new study, Hospital for Special Surgery (HSS) researchers found that 82% of patients who underwent total hip arthroplasty saw improvements in lower back pain after the procedure.
82% of Hip Patients Also Experience Lower Back Pain
1 min read Premium comments
#totalhipreplacementSecondary#lowerbackpain
It is not a guaranteed fix for everyone, they say; it appears still having a flexible spine is an important factor. Physicians should discuss with their patients the likelihood of hip surgery reducing pain in the lower back or if they should have spine surgery first.
“For patients, it is important to know that hip and spine arthritis often coexist, and the majority of the time, an individual’s back pain is better after hip replacement surgery,” said HSS hip and knee surgeon Jonathan M. Vigdorchik, M.D.
The study, “Does Low Back Pain Improve Following Total Hip Arthroplasty,” was online as a part of the American Academy of Orthopaedic Surgeons 2020 Virtual Education Experience.
In their study, Vigdorchik and his team compared data on 500 total hip replacement patients to see who would most likely see improvements.
Demographic data, Oswestry Disability Index (ODI) scores, and Visual Analog Scale (VAS) scores were calculated before surgery at 6 weeks and at one year postoperatively. And standing and sitting X-rays of the hip and lumbar spine were taken before and after the procedure.
Of the 500 patients, 41% had lower back pain before their hip surgeries. Of these, 82% felt better one year later. The average ODI in these patients preoperatively was 32±5% (moderate disability) compared with 9±3% (minimal disability) (p < 0.001).
The patients whose back pain went away showed a more than 10-degree change in sacral slope on the X-ray while those whose back pain remained had a less than 10-degree change in sacral slope which indicated a greater chance of spondylolisthesis.
“There is definitely a group of patients whose back pain predictably goes away after hip replacement surgery, and those are people who have flexible spines,” Vigdorchik said.
“Then there are certain patients who had a stiff, degenerative spine whose back pain did not go away, and that is because their spine arthritis had progressed to the point beyond which the hip was causing an effect.”
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.