Dissatisfied Hip Arthroscopy Patients? Might be Lumbosacral Transitional Vertebrae
Elizabeth Hofheinz, M.P.H., M.Ed.
New work published in the October 8, 2020 edition of the American Journal of Sports Medicine has looked at how the phenomenon of sacralization affects the outcomes of hip arthroscopy (HA). Also known as lumbosacral transitional vertebrae (LSTV), sacralization is a condition where the fifth vertebra is fused to the sacrum bone at the bottom of the spine.1
Noting the expansion of indications for HA as well as the increasing prevalence, the authors, all from Hospital for Special Surgery (HSS), retrospectively reviewed the prospectively collected Hip Arthroscopy Database at HSS for patients with LSTV who had hip arthroscopy between 2010 and 2017. The investigators identified 62 patients with LSTV and then matched them to controls. A variety of patient-reported outcome measures were collected at four different time points.
The researchers compared patient-reported outcome measures (PROMs) between patients undergoing HA with and without LSTV. In addition, they compared outcomes based on LSTV type.
“Preoperatively,” wrote the authors, “there was no significant difference between patients with and without LSTV on 3 of the 4 PROMs; how-ever, patients with LSTV did have significantly lower preoperative scores than controls for the Hip Outcome Score–Activities of Daily Living. Patients with LSTV reported significantly lower scores on all 4 PROMs at each postoperative time point. Radiographic data showed no significant difference in alpha angles across cohorts. When LSTV were compared by Castellvi type, types 3 and 4 tended to have lower scores than types 1 and 2; however, these comparisons were not significant.”
“The data supports our hypothesis that HA has less benefit in patients with LSTV as compared with patients without LSTV,” wrote the authors. “In patients with LSTV, careful evaluation of the anomaly is recommended to help guide surgical counseling and manage expectations.”
Co-author Anil S. Ranawat, M.D., Chief, Hip and Knee Division of Sports Medicine Institute at HSS, told OSN, “This is the first paper to show that people with spine pathology have inferior outcomes than people with normal spines but still have some improvement with surgery.”
“Although patients benefit from the procedure, the benefits are limited, and this is similar to the outcome of patients with spine pathology and total hips as well.”
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