AJSM - 2026-03-13 - Journal Article
Does Spine Pathology Influence Hip Arthroscopy Outcomes? A Systematic Review and Meta-analysis.
Thamrongskulsiri N, Moews LD, Morgan JT, Casanova F, Vega TF, Pérez Lloveras GO, Chahla J
Topics
Key Takeaway
Coexisting spine pathology reduces hip arthroscopy outcomes by 6–10 points across all functional PRO scales and doubles revision arthroscopy risk (OR 2.56) compared to spine-intact patients.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This systematic review and meta-analysis asked whether preexisting spine pathology degrades patient-reported outcomes and increases reoperation rates after hip arthroscopy for FAI. Fourteen comparative studies were pooled using random- or fixed-effects models with Modified Coleman Methodology Score quality assessment. Spine pathology patients showed significantly worse mHHS (MD -6.71), HOS-ADL (MD -6.13), HOS-SS (MD -10.45), NAHS (MD -7.16), and iHOT (MD -9.17), with higher revision arthroscopy (OR 2.56) and THA conversion (OR 1.46) rates; VAS pain scores did not differ significantly.
Key Limitation
Heterogeneous and inconsistent definitions of 'spine pathology' across included studies preclude identification of which specific spinal diagnoses drive the outcome deficit, limiting actionable preoperative risk stratification.
Original Abstract
BACKGROUND
Hip arthroscopy is increasingly used for femoroacetabular impingement, but outcomes may be influenced by coexisting spine pathology due to altered spinopelvic mechanics. Understanding this relationship is critical for patient counseling and surgical planning.
PURPOSE
To systematically review and meta-analyze the effect of preexisting spine pathology on patient-reported outcomes, revision hip arthroscopy, and conversion to arthroplasty after hip arthroscopy.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 3.
METHODS
A comprehensive literature search of PubMed, Ovid MEDLINE, and Scopus through July 2025 identified studies comparing hip arthroscopy outcomes between patients with and without spine pathology. Inclusion criteria were comparative studies reporting patient-reported outcomes or postoperative complications. Data extraction included demographic characteristics, type of spine pathology, surgical details, and outcomes. The Modified Coleman Methodology Score (MCMS) assessed study quality. Pooled mean difference (MD) and odds ratio (OR) with 95% CI were calculated using random- or fixed-effects models depending on heterogeneity.
RESULTS
Fourteen studies (4462 hips) were included, with 948 patients having spine pathology. Meta-analysis demonstrated statistically significantly inferior outcomes in the spine pathology group for the modified Harris Hip Score (MD, -6.71; P = .001), Hip Outcome Score-Activities of Daily Living (MD, -6.13; P = .004), Hip Outcome Score-Sports Subscale (MD, -10.45; P = .0002), Non-Arthritic Hip Score (MD, -7.16; P = .04), and International Hip Outcome Tool (MD, -9.17; P = .04) but not for visual analog scale scores for pain ( P = .28). Patients with spine pathology also had higher rates of revision hip arthroscopy (OR, 2.56; P = .04) and conversion to arthroplasty (OR, 1.46; P = .01).
CONCLUSION
Patients with preexisting spinal pathology had statistically significantly worse patient-reported outcomes after hip arthroscopy compared with patients without spinal pathology as well as higher rates of revision arthroscopy and conversion to arthroplasty.