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A Shorter Surgical Interval May be Associated with Improved Patient-reported Outcomes in Hip-spine Syndrome
Joshua Mathew1, Mitchell K Ng, Jonathan Dalton
1Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Study Design:
Retrospective Cohort Study.
Objective:
This study aimed to: (1) identify demographic differences based on the interval between surgeries; (2) compare differences in perioperative outcomes; (3) determine whether the interval between hip/spine surgery influences patient-reported outcomes (PROMs).
Summary Of Background Data:
The presence of concurrent hip and spine disease in hip-spine syndrome creates a unique challenge in surgical decision-making given overlapping disease, with ideal timing between index spine and hip procedures remaining unclear.
Methods:
A retrospective review was performed at a tertiary care center (2002-2025). Patients were included if they had undergone primary total hip arthroplasty and primary lumbar fusion in any sequence with an available 12-month HOOS score. Patients were divided based on the interval between surgery (<1-year and >1-year). Outcomes included patient reported outcomes (PROMs), number of revision surgeries, and time between procedures. Bivariate comparisons were made using t-tests and chi-square tests as appropriate.
Results:
179 patients (119>1-year, 60<1-year) were included, with no significant differences in demographics. Patients undergoing surgery within 1-year were more likely to have severe hip osteoarthritis and less likely to have mild disease compared to those whose procedures were greater than 1-year apart(P=0.003). There were no differences in revision rates. Order of surgery was associated with interval between procedures (P<0.001). Patients in the <1-year group were more likely to receive spine surgery first (P<0.001), started off with higher baseline ODI (P=0.034), and showed greater improvement after 12 months (P=0.004). HOOS scores improved in both groups, with most patients achieving MCID regardless of surgical interval.
Conclusion:
In patients with hip-spine syndrome, those treated within 1-year experienced larger improvements in ODI scores and similar 12-month PROMs compared with those treated more than 1-year part. These findings suggest that there may be a benefit to a shorter interval between surgeries in hip-spine syndrome patients, especially in patients with severe hip osteoarthritis.
