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Consider hip-spine syndrome as cause of continued hip pain after THR
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All hip surgeons regularly have patients who have osteoarthritis of the hip along with degenerative lumbar spinal stenosis or another degenerative spine condition. This is referred to as the hip-spine syndrome. Hip-spine syndrome is a fairly common problem, especially in elderly patients. Patients with osteoarthritis of the hip may present with problems similar to patients with low back problems and this can make it difficult to differentiate hip pathology from degenerative lumbar spine disease and determine the source of the pain.
All of this makes it challenging to decide on the best initial treatment that will reduce the patient’s pain most significantly.
Some hip-spine syndrome experts recommend that a thorough history and physical examination be performed to differentiate between hip and spine problems and to help with management of the syndrome. Sometimes testing is recommended, as well.
Hip surgeons should be aware of hip-spine syndrome and consider its possible existence for patients referred for total hip replacement (THR).
However, hip-spine syndrome is also a phenomenon that plays a major role in patients who are referred back because of pain following THR. These patients often — and should — receive our utmost attention, because conditions like deep infection, loose implants or soft-tissue impingement are also conditions these patients may present with that need acute attention and treatment. Tests should be done to determine the exact source of the patient’s pain. When all the test results are negative, we are left with a situation in which there is no clear reason for a patient’s hip pain. This reportedly occurs about 5% of the time. The majority of these patients will be individuals with hip-spine syndrome — pain in the hip area that stems from degenerative diseases of the spine.
Orthopaedic units that perform lower extremity joint replacement should consider meeting regularly with spine surgeons at their hospitals. Together, these teams may examine patients and discuss with them any unexplained hip pain, as well as manage cases of clearly diagnosed hip-spine syndrome. Collaboration makes sense when it comes to helping our patients who have or are suspected of having this syndrome.
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- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Rd., Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.