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Back Pain and Total Hip Arthroplasty: A Prospective Natural History Study

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Many patients with degenerative joint disease of the hip have substantial degeneration of the lumbar spine. These patients may have back and lower extremity pain develop after THA and it may be difficult to determine whether the source of the pain is the hip or spine.

Questions/purposes

We therefore: (1) identified the incidence/prevalence of pain in the lower back in a group of patients with end-stage arthritis of the hip undergoing THA; (2) described the natural history of low back pain in this cohort undergoing THA; and (3) determined factors that were predictive of persistent low back pain after THA.

Methods

We administered a detailed questionnaire and a diagram of the human body on which the patients could draw the site of their pain, to 344 patients preoperatively, at 6 weeks, 6 months, and 1-year after THA. Before the THA, 170 patients (49.4%) reported pain localized to the lower lumbar region, whereas 174 patients did not have low back pain.

Results

Low back pain was variable in location. Postoperatively, the low back pain resolved in 113 (66.4%) of the 170 patients. Thirty-seven of the remaining 57 patients had known spine disorders. Thirty-five of the 174 patients (20%) without prior low back pain had low back pain develop within 1 year postoperatively. The low back pain improved in 17 of these 35 patients; 12 of the remaining 18 patients had preexistent spine disorders. Pain radiating below the knee was associated most closely with preexisting spine disorders.

Conclusions

Hip and spine arthritis often coexist. Most patients who presented with hip arthritis and lower lumbar pain experienced resolution or improvement of their pain after THA.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Rothman Institute at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Javad Parvizi MD, Aidin E. Pour MD, Alan Hillibrand MD, Grigory Goldberg MD, Peter F. Sharkey MD & Richard H. Rothman MD, PhD

Authors
  1. Javad Parvizi MD
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  2. Aidin E. Pour MD
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  3. Alan Hillibrand MD
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  4. Grigory Goldberg MD
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  5. Peter F. Sharkey MD
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  6. Richard H. Rothman MD, PhD
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Corresponding author

Correspondence to Javad Parvizi MD.

Additional information

One or more of the authors (JP, RHR) are consultants to Stryker Orthopaedics and their institution has received funding from Stryker Orthopaedics. The received funding was not related to this project.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

This work was performed at the Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA.

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Parvizi, J., Pour, A.E., Hillibrand, A. et al. Back Pain and Total Hip Arthroplasty: A Prospective Natural History Study. Clin Orthop Relat Res 468, 1325–1330 (2010). https://doi.org/10.1007/s11999-010-1236-5

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  • DOI: https://doi.org/10.1007/s11999-010-1236-5

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