Hip-spine syndrome: the effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip

Spine (Phila Pa 1976). 2007 Sep 1;32(19):2099-102. doi: 10.1097/BRS.0b013e318145a3c5.


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 affect of THR on LBP.

Summary of background data: Hip osteoarthritis causes abnormal gait and spinal sagittal alignment and is associated with LBP.

Methods: All consecutive adults scheduled for THR in our department 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 scores were used to evaluate hip- and spine-related symptoms, respectively, as were visual analogue scales (VAS) and sagittal spinal radiographs.

Results: Twenty-five patients (10 males; age range, 32-84 years) were evaluated. Both spinal and hip pain and function were significantly better following THR. The mean preoperative LBP VAS score of 5.04 was 3.68 after THR (P = 0.006). The mean preoperative Oswestry score of 36.72 was 24.08 after THR (P = 0.0011). Clinical improvement was maintained and enhanced at the 2-year follow-up. The mean hip pain VAS score was 7.08 before THR and 2.52 after THR (P < 0.01). The mean Harris Hip Score was 45.74 before and 81.8 after surgery (P < 0.01). There were no changes in the radiographic measurements.

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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip*
  • Gait*
  • Humans
  • Low Back Pain / diagnostic imaging
  • Low Back Pain / etiology*
  • Low Back Pain / physiopathology
  • Low Back Pain / surgery
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / complications
  • Osteoarthritis, Hip / diagnostic imaging
  • Osteoarthritis, Hip / physiopathology
  • Osteoarthritis, Hip / surgery*
  • Pain Measurement
  • Postural Balance*
  • Prospective Studies
  • Radiography
  • Recovery of Function
  • Reproducibility of Results
  • Severity of Illness Index
  • Syndrome
  • Time Factors
  • Treatment Outcome
  • Walking