Back Pain and Its Effects on Early Patient-Reported Outcome Measures in Total Hip Arthroplasty

Abstract

AbstractThe success of total hip arthroplasty (THA) may be negatively impacted in those with back pain as evidenced by patient-reported outcome (PRO) scores. The goal of this study was to determine whether the hip–spine relationship, as it relates to the presence of preoperative back pain, affected THA outcomes, and PRO scores. We retrospectively reviewed 243 patients who underwent primary THA and completed the Hip disability and Osteoarthritis Outcome Score Junior (HOOS Jr.), back pain questionnaire, and the Forgotten Joint Score-12 (FJS-12) preoperatively and at 12-weeks postoperatively. Patients were separated into two cohorts: those with preoperative back pain and those who were back pain free. Analysis was performed using t-test and chi-square to determine differences in demographic data. Regression analysis was utilized to account for differences in demographic data. There were significant demographic differences, which included body mass index, American Society of Anesthesiologists, smoking status, and length of stay between the two cohorts. Patients with preoperative back pain had lower preoperative HOOS Jr. scores than their counterparts (44.93 vs. 55.2; p = 0.029). Additionally, the preoperative back pain free group reported better FJS-12 and HOOS Jr. scores at 12-weeks postoperatively (FJS-12:62.00 vs. 43.32, p < 0.0001; HOOS Jr.: 81.33 vs. 75.68, p = 0.029). Patients with preoperative back pain had lower preoperative PRO scores and overall experienced less postoperative satisfaction and greater disability than patients who were back pain free. However, these patients' preoperative to postoperative improvement in PRO scores (delta change) was greater than that of the back pain free patients. These results suggest that THA may alter the hip-spine mechanics and potentially provide a reprieve from back pain.