Hip-spine syndrome leads to failed hip replacement and lumbar spinal fusion

Dr. David Woznica ProlotherapistDavid N. Woznica, MD 

Throughout our research and articles, we constantly draw attention to the problems of whole joint disease. In many cases, you simply can’t fix one component of a joint and expect to meet the patient’s expectations of recovery and cure.

The same can be said of the hip-spine complex.

Before you continue with this article, do you have a question about hip-spine pain? You can get help and information from our Caring Medical staff.

In many patients you cannot simply look at the hip and fix their hip pain without examining their low back problems. Focusing on the hip without an examination of the lower back will lead to a treatment that will not  meet the patient’s expectations of recovery and cure.

In that same regard you cannot fix the problems of the lower back without examining if the problems the patient is facing is also being generated from the hip.
Pelvis Fusion X-ray

Hip-Spine Syndrome is born after doctors notice patients still have pain after hip replacement and spinal fusion

Research from the Vanderbilt Orthopaedic Institute published in the The Journal of the American Academy of Orthopaedic Surgeons warns doctors about wrong surgeries.

“The incidence of symptomatic osteoarthritis of the hip and degenerative lumbar spinal stenosis is increasing in our aging population. Because the subjective complaints can be similar, it is often difficult to differentiate intra- and extra-articular hip pathology (intra meaning the pain is in the hip joint at the ball and socket location, extra means the supporting ligaments and tendons that lead to hip instability) from degenerative lumbar spinal stenosis.

These conditions can present concurrently, which makes it challenging to determine the predominant underlying pain generator.  . . Determining the potential benefit from surgical intervention and the order in which to address these conditions are of utmost importance for patient satisfaction and adequate relief of symptoms.”(1)

Doctors at the University Hospitals Cleveland Medical Center wrote in the September 2017 edition of Orthopaedics and traumatology, surgery and research:

Here are more factors the doctors discussed:

Of course we believe that future research is necessary regarding optimal NON-surgical treatment of these patients.

Patients with Hip-Spine Syndrome made worse by Hip Replacement and Spinal Fusion

University and hospital researchers in Sweden made the connection between poor hip replacement outcomes and previous lumbar fusion surgery.

Writing in the Joint and Bone journal, they examined patients who first had the lumbar surgery, then proceeded later on to total hip replacement. Their research conclusions are presented here:

These same unfortunate results had been previously reported earlier in 2017 by doctors at the Department of Orthopaedic Surgery, University of California, San Francisco in The Journal of arthroplasty:

The UCSF researchers concluded their study with:

Understanding reduced range of hip motion causing more lower back pain

Doctors from Washington University School of Medicine in St. Louis and Northwestern University Feinberg School of Medicine wrote in the The Journal of orthopaedic and sports physical therapy of patients with hip-spine syndrome with known hip arthritis and reduced range of hip motion.

The researchers concluded: Physical examination findings indicating hip dysfunction are common in patients presenting with low back pain. Patients with low back pain and positive hip examination findings have more pain and worse function compared to patients with low back pain but without positive hip examination findings.(5)

In a January 2017 paper entitled: The Hip-Spine Effect: A Biomechanical Study of Ischiofemoral Impingement Effect on Lumbar Facet Joints, Doctors at Baylor University and the University of Texas found a relation between ischiofemoral impingement and lumbar facet joint load during hip extension.

They suggested that limited terminal hip extension due to simulated  ischiofemoral impingement significantly increases L3-4 and L4-5 lumbar facet joint load when compared with non- ischiofemoral impingement hips.

This  study directly links  ischiofemoral impingement to increased lumbar facet loads and supports the clinical findings of ischiofemoral impingement causing lumbar pathology. Assessing and treating hip disorders that limit extension could have benefit in patients with concomitant lower back symptoms.(6)

Non-surgical treatment of hip-spine syndrome

At Caring Medical, we have successfully treated patients with problems of the hip-spine and pelvis complex with Prolotherapy, the video above and below will help demonstrate the technique and answer general questions.

If you have questions about hip spine complex problems, get help and information from our Caring Medical staff

1 Devin CJ, McCullough KA, Morris BJ, Yates AJ, Kang JD. Hip‐spine syndrome. Journal of the American Academy of Orthopaedic Surgeons. 2012 Jul 1;20(7):434-42. [Google Scholar]

2 Weinberg DS, Gebhart JJ, Liu RW. Hip-Spine Syndrome: a cadaveric analysis between osteoarthritis of the lumbar spine and hip joints. Orthopaedics & Traumatology: Surgery & Research. 2017 May 31. [Google Scholar]

3 Eneqvist T, Nemes S, Brisby H, Fritzell P, Garellick G, Rolfson O. Lumbar surgery prior to total hip arthroplasty is associated with worse patient-reported outcomes. Bone Joint J. 2017 Jun 1;99(6):759-65. [Google Scholar]

4 Barry JJ, Sing DC, Vail TP, Hansen EN. Early Outcomes of Primary Total Hip Arthroplasty After Prior Lumbar Spinal Fusion. J Arthroplasty. 2017 Feb;32(2):470-474. [Google Scholar]

5 Prather H, Cheng A, Steger-May K, Maheshwari V, Van Dillen L. Hip and Lumbar Spine Physical Examination Findings in People Presenting With Low Back Pain, With or Without Lower Extremity Pain. journal of orthopaedic & sports physical therapy. 2017 Mar;47(3):163-72. [Google Scholar]

6 Gómez-Hoyos J, Khoury A, Schröder R, Johnson E, Palmer IJ, Martin HD. The Hip-Spine Effect: A Biomechanical Study of Ischiofemoral Impingement Effect on Lumbar Facet Joints. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2017 Jan 31;33(1):101-7. [Google Scholar]

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