Does Spine Pathology Influence Hip Arthroscopy Outcomes? A Systematic Review and Meta-analysis.

BACKGROUND

Hip arthroscopy is increasingly used for femoroacetabular impingement, but outcomes may be influenced by coexisting spine pathology due to altered spinopelvic mechanics. Understanding this relationship is critical for patient counseling and surgical planning.

PURPOSE: To systematically review and meta-analyze the effect of preexisting spine pathology on patient-reported outcomes, revision hip arthroscopy, and conversion to arthroplasty after hip arthroscopy.

STUDY

DESIGN

Systematic review and meta-analysis; Level of evidence, 3.

METHODS

A comprehensive literature search of PubMed, Ovid MEDLINE, and Scopus through July 2025 identified studies comparing hip arthroscopy outcomes between patients with and without spine pathology. Inclusion criteria were comparative studies reporting patient-reported outcomes or postoperative complications. Data extraction included demographic characteristics, type of spine pathology, surgical details, and outcomes. The Modified Coleman Methodology Score (MCMS) assessed study quality. Pooled mean difference (MD) and odds ratio (OR) with 95% CI were calculated using random- or fixed-effects models depending on heterogeneity.

RESULTS

Fourteen studies (4462 hips) were included, with 948 patients having spine pathology. Meta-analysis demonstrated statistically significantly inferior outcomes in the spine pathology group for the modified Harris Hip Score (MD, -6.71; P = .001), Hip Outcome Score-Activities of Daily Living (MD, -6.13; P = .004), Hip Outcome Score-Sports Subscale (MD, -10.45; P = .0002), Non-Arthritic Hip Score (MD, -7.16; P = .04), and International Hip Outcome Tool (MD, -9.17; P = .04) but not for visual analog scale scores for pain (P = .28). Patients with spine pathology also had higher rates of revision hip arthroscopy (OR, 2.56; P = .04) and conversion to arthroplasty (OR, 1.46; P = .01).

CONCLUSION

Patients with preexisting spinal pathology had statistically significantly worse patient-reported outcomes after hip arthroscopy compared with patients without spinal pathology as well as higher rates of revision arthroscopy and conversion to arthroplasty.