Hip-Spine Syndrome: The Effect of Total Hip Replacement Surgery on Low Back Pain in Severe Osteoarthritis of the Hip

Peleg Ben-Galim, MD; Tal Ben-Galim, MD; Nahshon Rand, MD; Amir Haim, MD; John Hipp, PhD; Shmuel Dekel, MD, PhD; Yizhar Floman, MD


Spine. 2007;32(19):2099-2102. 

In This Article

Abstract and Introduction

Study Design: Prospective clinical study on the effect of total hip replacement surgery (THR) on low back pain (LBP) in patients with severe hip osteoarthritis.
Objective: To assess the affect of THR on LBP.
Summary of Background Data: Hip osteoarthritis causes abnormal gait and spinal sagittal alignment and is associated with LBP.
Methods: All consecutive adults scheduled for THR in our department due to severe hip osteoarthritis were assessed by an independent investigator before surgery and 3 months and 2 years post-THR. The Harris Hip Score and the Oswestry scores were used to evaluate hip- and spine-related symptoms, respectively, as were visual analogue scales (VAS) and sagittal spinal radiographs.
Results: Twenty-five patients (10 males; age range, 32-84 years) were evaluated. Both spinal and hip pain and function were significantly better following THR. The mean preoperative LBP VAS score of 5.04 was 3.68 after THR (P = 0.006). The mean preoperative Oswestry score of 36.72 was 24.08 after THR (P = 0.0011). Clinical improvement was maintained and enhanced at the 2-year follow-up. The mean hip pain VAS score was 7.08 before THR and 2.52 after THR (P < 0.01). The mean Harris Hip Score was 45.74 before and 81.8 after surgery (P < 0.01). There were no changes in the radiographic measurements.
Conclusion: Both LBP and spinal function were improved following THR. This study demonstrates the clinical benefits of THR on back pain and is the first to clinically validate hip-spine syndrome as hypothesized by Offierski and MacNab in 1983.

Severe osteoarthritis of the hip joint may cause abnormal spinal sagittal alignment and difficulty in maintaining proper balance as well as a wobbling gait. It can also be associated with low back pain (LBP). This syndrome (hip-spine) was originally described by Offierski and MacNab over 3 decades ago;[1] and although it is frequently cited, there have been no prospective clinical reports on the influence of total hip replacement (THR) surgery on LBP, spinal function, and symptomatology. Offierski and MacNab had described a case of a 72-year-old female patient who had what they called secondary hip-spine syndrome. She had low back and anterior thigh pain, degenerative changes in the lumbar spine, and osteoarthritis of both hips. Her back pain disappeared after she underwent bilateral THR.

THR is effective in alleviating hip pain and improves hip function and gait.[2,7] The purpose of the current study is to test MacNab's hip-spine syndrome in a clinical setting by assessing whether relief of hip symptoms can also relieve back pain. We hypothesized that improvement in hip function and reduction of hip pain following THR would also have a positive effect on spinal posture and symptoms.


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