The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: Letter to the Editor

Dear Editor: Recently, we read the article entitled ‘‘The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: A Nested Case-Control Analysis’’ by Beck et al. They found that compared with the no lumbosacral pathology group, the lumbosacral pathology group achieved significantly worse short-term meaningful clinical outcomes after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We appreciate the work that has been done by the authors and think this finding is of value for clinicians in decision-making. However, their conclusion may also lead to some degree of misunderstanding. In the clinic, we find middle-aged patients with FAIS combined with lumbosacral disease (disc herniation, degenerative disc changes, and spinal stenosis) to be common. As described in the article, the lumbosacral pathology group could still benefit from significant improvement following hip arthroscopy in terms of patient-reported outcome (PRO) scores when compared with the preoperation dates, indicating that patients with lumbosacral pathology were also good candidates for arthroscopic hip surgery. Previous studies showed that patients with spinal diseases (such as diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis) involving the hip joint or hip disease combined with spine disease could achieve good clinical outcomes after arthroscopic hip surgery. It seems that spine disease is certainly not a contraindication to hip arthroscopy. It is important to identify which spinal diseases influence FAIS outcomes. Therefore, we believe that it is meaningful to make comparisons between the subcategories of the lumbosacral pathology group and the no lumbosacral pathology control group. One of the strengths of this article was the matched pair analysis. However, there remain several important confounding factors, such as arthritic changes, longer duration of symptoms, and intra-articular diagnoses and procedures not being strictly matched, potentially affecting outcomes. Furthermore, this study involved a 2-year follow-up, and it is unclear whether the outcomes will continue to improve into the future, because a history of hip surgery may also have a positive effect in relieving symptoms of lumbosacral disease. It should also be noted that there was a mistake in the article. In the Results section, the authors claimed that 83 patients with lumbosacral pathology were included. However, we found the description in Table 2 for the number of patients confusing: ‘‘Disc pathology (51), Surgery (21), Stenosis (13), and Fracture (1)’’ outnumbered the total number of patients. What is more, in order to make the data expression more clear, the number of patients (n) of each group should be described in the Tables 1, 3, and 4. Again, much appreciation is extended to the authors for bringing this topic to discussion and their effort in performing the study. However, which lumbosacral diseases adversely affect outcomes of hip arthroscopy treatment of FAIS and how remain to be studied in the future. If possible, we hope the authors will address the abovementioned issues and make the necessary changes to make this article more credible. Mingjin Zhong, MD Weimin Zhu, MD Kan Ouyang, MD Shenzhen, China