If You Need a Hip Replacement, Get Your Low Back Fixed First!

It’s always great to see enlightened physicians tying together how one part of the body impacts the other. We’ve done a great disservice to patients by educating them that their knee, hip, and spine are separate instead of all one big machine. Now a recent study shows us yet another connection between the low back and hip replacement complications.

First, when I tell patients that problems in their hip or knee or ankle may have originated in their low back, they look at me like I just told them that there’s an alien living inside them. The idea that their body is one connected machine is that foreign. How did we get here and what evidence is there that different parts of the system impact each other?

It’s All Connected

We’ve done a great disservice to patients by orthopedic hyper-specialization. The messaging to patients has been that since there are hip specialists and spine experts, then the hip and the spine are two different machines. Yet, in fact, the literature continues to show that the spine and leg are one machine designed to transfer force. While that machine has specialized areas called the hip and the spine, they are intimately interconnected.

Research supports these hip and knee connections. For example, one study found that in female runners with kneecap pain, the stress on the knee was caused by weak gluteal muscles that weren’t contracting appropriately to keep the hip in proper position. Another recent investigation demonstrated that the position of the femur, which is controlled at the hip, could lead to poor tracking of the kneecap, which can lead to arthritis and cartilage injuries.

Taking this a step further, the hip and knee and even the ankle and foot are all supplied and controlled by spinal nerves in your low back.

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Low Back and Hip Replacement: The New Research

The latest study on this topic looked the connection between low back and hip replacement by looking at patients who had various low back conditions at the time of their hip replacement surgery. This spanned everything from a herniated disc to degenerative disc disease with arthritis. Interestingly, in patients with a low back diagnosis, they were up to twice as likely to experience complications from a total hip replacement surgery. In this case that the device would dislocate. This makes sense as abnormal motion in the low back likely places abnormal pressure on the new hip device. In addition, other complications were more likely and these included the need for revision surgery, fracture around the new device, and infection.

The upshot? If you need a hip replacement, make sure you get your back fixed before surgery! This can often be accomplished without the need for back surgery. In addition, all the parts of your body are connected, so don’t believe for a second that what happens in your hips isn’t impacted by what happens in your back!

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile