TY - JOUR
T1 - The Prevalence of Hip Pathologies in Adolescent Idiopathic Scoliosis
AU - Bortz, Cole
AU - Williamson, Tyler K.
AU - Adenwalla, Ammar
AU - Naessig, Sara
AU - Imbo, Bailey
AU - Passfall, Lara
AU - Krol, Oscar
AU - Tretiakov, Peter
AU - Joujon-Roche, Rachel
AU - Moattari, Kevin
AU - Sagoo, Navraj
AU - Ahmad, Salman
AU - Singh, Vivek
AU - Owusu-Sarpong, Stephane
AU - Vira, Shaleen
AU - Diebo, Bassel
AU - Passias, Peter G.
N1 - Publisher Copyright:
© 2022
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Adolescent idiopathic scoliosis (AIS) is the most common form of abnormal spine curvature observed in patients age 10 to 18. Typically characterized by shoulder height and waistline asymmetry, AIS may drive uneven distribution of force in the hips, leading to increased rates of concurrent hip diagnoses. The relationship between AIS and concurrent hip diagnoses is underexplored in the literature, and to date, there has been little research comparing rates of hip diagnoses between patients with AIS and those unaffected. Purpose: Assess differences in rates and clusters of hip diagnoses between patients with AIS and those unaffected. Study design: Retrospective review of Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS). Patient sample: 224,504 weighted inpatient discharges. Outcome measures: Rates of hip diagnoses. Methods: Patients in the NIS database (2005–2013) ages 10–18 years were isolated. Patients were grouped by those diagnosed with AIS (ICD-9: 737.30) and those unaffected. Patient groups were propensity score matched (PSM) for age. Means comparison tests assessed differences in demographic, comorbidity, and diagnosis profiles between patient groups for corresponding age categories. ICD-9 codes were used to identify specific hip diagnoses. Results: Following PSM, 24,656 AIS and 24,656 unaffected patients were included. The AIS patient group was comprised of more females (66% vs 59%) and had lower rates of obesity (2.4% vs 3.5%, both p < 0.001). Overall, 1.1% of patients had at least one hip diagnosis: congenital deformity (0.31%), developmental dysplasia (0.24%), recurrent dislocation (0.18%), isolated dislocation (0.09%), osteonecrosis (0.08%), osteochondrosis (0.07%), acquired deformity (0.03%), and osteoarthritis (0.02%). AIS patients had lower rates of osteonecrosis (0.04% vs 0.12%, p = 0.003), but higher rates of all other hip diagnoses, including dysplasia (0.41% vs 0.07%, p < 0.001), recurrent dislocation (0.32% vs 0.03%, p < 0.001), isolated dislocation (0.13% vs 0.06%, p < 0.001), and osteoarthritis (0.04% vs 0.01%, p = 0.084. Co-occurrences of hip diagnoses were relatively rare, with 0.03% patients having more than one hip diagnosis. Rates of co-occurring hip diagnoses did not differ between AIS and unaffected groups (0.04% vs 0.02%, p = 0.225). Conclusions: Compared to unaffected patients of similar ages, patients with AIS had higher overall rates of hip diagnoses, including dysplasia and recurrent dislocation. A higher trend of precocious osteoarthritis was also observed at a higher rate in AIS patients, although this difference was not statistically significant. Our results present an argument for surgical realignment in the coronal and sagittal planes to neutralize asymmetrical forces in the hips, and suggest the need for increased awareness and clinical screening for hip-related disorders in AIS patients. Level of Evidence: III.
AB - Background: Adolescent idiopathic scoliosis (AIS) is the most common form of abnormal spine curvature observed in patients age 10 to 18. Typically characterized by shoulder height and waistline asymmetry, AIS may drive uneven distribution of force in the hips, leading to increased rates of concurrent hip diagnoses. The relationship between AIS and concurrent hip diagnoses is underexplored in the literature, and to date, there has been little research comparing rates of hip diagnoses between patients with AIS and those unaffected. Purpose: Assess differences in rates and clusters of hip diagnoses between patients with AIS and those unaffected. Study design: Retrospective review of Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS). Patient sample: 224,504 weighted inpatient discharges. Outcome measures: Rates of hip diagnoses. Methods: Patients in the NIS database (2005–2013) ages 10–18 years were isolated. Patients were grouped by those diagnosed with AIS (ICD-9: 737.30) and those unaffected. Patient groups were propensity score matched (PSM) for age. Means comparison tests assessed differences in demographic, comorbidity, and diagnosis profiles between patient groups for corresponding age categories. ICD-9 codes were used to identify specific hip diagnoses. Results: Following PSM, 24,656 AIS and 24,656 unaffected patients were included. The AIS patient group was comprised of more females (66% vs 59%) and had lower rates of obesity (2.4% vs 3.5%, both p < 0.001). Overall, 1.1% of patients had at least one hip diagnosis: congenital deformity (0.31%), developmental dysplasia (0.24%), recurrent dislocation (0.18%), isolated dislocation (0.09%), osteonecrosis (0.08%), osteochondrosis (0.07%), acquired deformity (0.03%), and osteoarthritis (0.02%). AIS patients had lower rates of osteonecrosis (0.04% vs 0.12%, p = 0.003), but higher rates of all other hip diagnoses, including dysplasia (0.41% vs 0.07%, p < 0.001), recurrent dislocation (0.32% vs 0.03%, p < 0.001), isolated dislocation (0.13% vs 0.06%, p < 0.001), and osteoarthritis (0.04% vs 0.01%, p = 0.084. Co-occurrences of hip diagnoses were relatively rare, with 0.03% patients having more than one hip diagnosis. Rates of co-occurring hip diagnoses did not differ between AIS and unaffected groups (0.04% vs 0.02%, p = 0.225). Conclusions: Compared to unaffected patients of similar ages, patients with AIS had higher overall rates of hip diagnoses, including dysplasia and recurrent dislocation. A higher trend of precocious osteoarthritis was also observed at a higher rate in AIS patients, although this difference was not statistically significant. Our results present an argument for surgical realignment in the coronal and sagittal planes to neutralize asymmetrical forces in the hips, and suggest the need for increased awareness and clinical screening for hip-related disorders in AIS patients. Level of Evidence: III.
KW - Adolescent idiopathic scoliosis (AIS)
KW - Hip-spine
KW - Pediatric spine
KW - Scoliosis
KW - Spine
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U2 - 10.1016/j.jor.2022.02.017
DO - 10.1016/j.jor.2022.02.017
M3 - Article
C2 - 35360471
AN - SCOPUS:85126949770
SN - 0972-978X
VL - 31
SP - 29
EP - 32
JO - Journal of Orthopaedics
JF - Journal of Orthopaedics
ER -