Editorial Commentary: Hip arthroscopy in patients with symptomatic spine pathology: Patient education supported by diagnostic injections is the key to satisfactory outcomes.

Concomitant correctable and uncorrectable pathologies can impact outcomes after any orthopedic procedure. The relationship between hip joint disorders and spine related disorders have been increasingly recognized and reported in the literature. A number of studies have reported poorer outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) with associated symptomatic low back and sacroiliac dysfunction. A few studies, however, have noted that the magnitude of improvement after hip arthroscopy is similar between patients with and without spine pathology despite inferior outcomes associated with symptomatic spine disease. A couple of studies have contradicted this data and noted comparable outcomes after hip arthroscopy for isolated hip pain vs those with hip and spine pain. This is clearly a complex kinetic chain association, and the contradicting literature might be more about how we evaluate the data, set appropriate physician / patient expectations, perform a thorough work up including diagnostic injections, and carefully navigate our way through this patient population rather than buying into a concrete conclusion one way or another. When faced with a patient population riddled with hip and spine related pathology, we are walking through a mine field of unpredictable patient related outcomes. We need to use our evidence and experience-based map to avoid these mines of failure and safely march towards a successful outcome.