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

A number of patients have both hip pain due to arthritis and back pain.  Surgeons at The Centre for Hip & Knee Surgery, in common with other surgeons, tend to advise patients that after a total hip replacement, an improvement in their back symptoms often occurs (although they cannot guarantee this). 

This interesting study is the first to prove objectively that such an improvement does occur.

 Peleg Ben-Galim, MD,* Tal Ben-Galim, MD,^† Nahshon Rand, MD,^‡ Amir Haim, MD,* John Hipp, PhD,^§ Shmuel Dekel, MD, PhD,* Yizhar Floman, MD^‡

*Department of Orthopedic Surgery “B,” Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
^†Hadassah Medical School, Kiryat Hadassah, Jerusalem, Israel
^‡Israel Spine Center, Assuta Hospital, Tel-Aviv, Israel
^§Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX

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 effect of THR on LBP.
Summary of Background Data: Hip osteoarthritis causes abnormal gait (limp) and abnormal spinal  alignment and this is associated with LBP.
Methods: All consecutive adults scheduled for THR 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 Spine scores were used to evaluate hip- and spine-related symptoms, respectively, as were visual analogue scales (VAS) and spinal radiographs.

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