THA First: Low Back Pain in Patients with Both Hip Osteoarthritis and Lumbar Degenerative Disease is Relieved after Total Hip Arthroplasty

Abstract Background: With the aging of population, the number of patients suffering from hip osteoarthritis complicated with lumbar degenerative disease is increasing. Both diseases may require surgery, however, which is first? the sequence of total hip arthroplasty (THA) and lumbar surgery remains controversial. Methods: The data of our hospital, from 2010 to 2019 were retrieved, and a group of patients who had undergone total hip replacement (THA, n = 153) and also suffered from lumbar degenerative diseases were identified. We studied the improvement of hip joint function and the relief of low back pain (LBP), and also discussed the effect of unilateral and bilateral THA on the relief of LBP. Results: The LBP visual analysis scale (VAS) of 153 patients decreased from (4.13 ± 1.37) preoperatively to (1.90 ± 1.44) postoperatively. The average Harris Hip score (HHS) increased from 45.33 ± 13.23 preoperatively to 86.44 ± 7.59 postoperatively of the latest follow-up. According to Japanese Orthopedic Association (JOA) scoring system, the proportion of patients with good response to treatment in the clinical results of these 153 patients reached 93.46%. LBP VAS decreased from 4.18 ± 1.38 preoperatively to 1.95 ± 1.49 postoperatively in unilateral group and from 3.94 ± 1.32 preoperatively to 1.73 ± 1.23 postoperatively in bilateral group respectively. These results showed that the lumbar pain was relieved significantly after surgery. Conclusion: THA can relieve LBP while relieve hip pain and restore hip function. And the relief of LBP and recovery of lumbar function in unilateral operation group were better than those in bilateral operation group. These findings can be helpful to surgeons in making decisions. For patients with both hip disease and lumbar degenerative disease, THA first may bring additional benefits to patients.