Spine - 2026-08-26 - Journal Article
Spine Surgery First Is Associated with Greater 1-year HOOS Improvement in Patients with Hip-spine Syndrome.
Mathew J, Ng MK, Dalton J, Lee Y, Baek G, Eichbaum Y, Green W, Hitchner M, Vanichkachorn A, Barksdale G, Buzzetta A, Fras T, Venkatesh D, Farooqi A, Martinazzi B, Giakas A, Mastrokostas P, Kaye ID, Kurd MF, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK
Topics
Key Takeaway
In hip-spine syndrome patients undergoing both lumbar fusion and THA, spine-first sequencing was an independent predictor of greater 1-year HOOS improvement (β: 8.04, p=0.039) compared to hip-first sequencing.
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Summary
This retrospective single-center study (2002–2025) compared 1-year HOOS outcomes in hip-spine syndrome patients who underwent lumbar fusion and THA in either sequence. Spine-first patients had significantly greater HOOS improvement (37.6 vs. 30.2, p=0.045), proceeded to their second surgery faster (2.24 vs. 4.03 years, p<0.001), and were more likely to complete both surgeries within 1 year (45.7% vs. 11.1%, p<0.001). Multivariable analysis confirmed spine-first sequencing as an independent predictor of HOOS improvement (β=8.04, 95% CI 0.47–15.60, p=0.039), though the spine-first cohort also had significantly more severe hip OA at baseline (66 vs. 18 patients, p=0.006).
Key Limitation
The significant baseline imbalance in hip OA severity (more severe OA in the spine-first group) is not fully eliminable by multivariable adjustment and may confound the HOOS improvement advantage attributed to sequencing.
Original Abstract
STUDY DESIGN
Retrospective Cohort Study.
OBJECTIVE
This study aimed to: (1) compare demographic differences between spine-first and hip-first patients; (2) identify differences in perioperative outcomes; (3) determine whether surgical sequencing between hip and spine surgery influences patient reported outcomes (PROMS).
SUMMARY OF BACKGROUND DATA
Hip-spine syndrome refers to coexisting lumbar degenerative stenosis and hip osteoarthritis. Surgical counseling remains challenging due to the symptomatic overlap between hip and spine disease, and there is no clear consensus on which disease should be addressed first.
METHODS
A retrospective review of a tertiary care center was performed (2002-2025). Patients were included if they had undergone a lumbar spinal fusion and a total hip arthroplasty in any sequence with an available 12-month Hip Disability and Osteoarthritis Outcome Score (HOOS). Patients were excluded if they had a history of spine revision surgery prior to hip surgery or hip revision surgery prior to spine surgery. HOOS scores were the primary outcome. Descriptive statistics were performed, and bivariate comparisons were made as appropriate. Multivariable analysis was performed to identify predictors of 1-year improvement in HOOS scores.
RESULTS
179 patients (116 Spine-first, 63 Hip-first) were included. Overall, there were no significant demographic differences between groups. A greater number of patients with severe hip osteoarthritis underwent spine surgery first rather than hip surgery (66 vs. 18, P=0.006). There were no significant differences regarding hip and spine revision surgeries between both groups. Spine-first patients underwent their second surgery in less time compared to hip-first patients (2.24 y vs. 4.03 y, P<0.001). Furthermore, spine-first patients were more likely to have their second surgery within 1-year (45.7% vs. 11.1%), P<0.001). Regarding PROMS, spine-first patients reported better 1-year improvement in HOOS scores (37.6 vs. 30.2, P=0.045). Multivariable analysis revealed that undergoing spine surgery first was an independent predictor of 1-year HOOS improvement (β: 8.04 [0.47-15.60], P=0.039).
CONCLUSION
In this retrospective cohort, undergoing spine surgery first was associated with a modest 1-year HOOS improvement in hip-spine syndrome patients. It is important to note that these findings cannot speak towards causality, and further work is needed to validate these findings in prospective settings.