Which Should Be Operated on First—The Spine or the Hip? A Survey-Based Study on Treatment Order in Patients with Concurrent Degenerative Disorders of the Hip and Spine
Abstract
Introduction: In patients presenting with both hip osteoarthritis (OA) and spinal pathology, and where symptoms from both conditions are severe enough to warrant surgical intervention, determining the optimal order of treatment can be challenging. Objective: To identify surgeons’ preferences and the rationale behind the treatment order in patients with hip OA and five different lumbar spine disorders. Materials and Methods: A survey-based study was conducted among hip and spine specialists.Respondents were asked which condition they would operate on first in five clinical scenarios involving hip OA combined with: 1) lumbar spinal stenosis with neurogenic claudication, 2) low-grade lumbar spondylolisthesis with radicular pain, 3) lumbar disc herniation with muscle weakness, 4) degenerative lumbar scoliosis with sagittal imbalance, and 5) thoracolumbar disc herniation with myelopathy. Results: The percentage of hip specialists who recommended addressing the hip first was: 45% for scenario 1, 61% for scenario 2, 20% for scenario 3, 71% for scenario 4, and 26% for scenario 5. Among spine specialists, those percentages were: 56%, 69%, 9%, 77%, and 16%, respectively. There was no consistent agreement between specialists from different fields—or even within the same specialty—as indicated by a low kappa concordance index across all scenarios. Conclusions: Given the low level of agreement among both hip and spine surgeons, interdisciplinary discussions are essential when managing complex cases. An individualized treatment plan should be developed for each patient, particularly when the spinal pathology ismore complex.Downloads
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