Hip-related groin pain, patient characteristics and patient-reported outcomes in patients referred to tertiary care due to longstanding hip and groin pain: a cross-sectional study

Anders Pålsson; Ioannis Kostogiannis; Håkan Lindvall; Eva Ageberg

doi:10.1186/s12891-019-2794-7

journal article Open Access Sep 14, 2019

Hip-related groin pain, patient characteristics and patient-reported outcomes in patients referred to tertiary care due to longstanding hip and groin pain: a cross-sectional study

Anders Pålsson

Ioannis Kostogiannis Håkan Lindvall Eva Ageberg

BMC Musculoskeletal Disorders Vol. 20 No. 1 · Springer Science and Business Media LLC

View at Publisher Save 10.1186/s12891-019-2794-7

Abstract

Abstract

Background
Due to advances in hip arthroscopy, the number of surgical procedures has increased dramatically. The diagnostic challenge in patients with longstanding hip and groin pain, as well as the increasing number of hip arthroscopies, may lead to a higher number of patients referred to tertiary care for consideration for surgery. Therefore, the aims were: 1) to describe the prevalence of hip-related groin pain in patients referred to tertiary care due to longstanding hip and groin pain; and 2) to compare patient characteristics and patient-reported outcomes for patients categorized as having hip-related groin pain and those with non-hip-related groin pain.

Methods
Eighty-one patients referred to the Department of Orthopedics at Skåne University Hospital for longstanding hip and groin pain were consecutively included and categorized into hip-related groin pain or non-hip-related groin pain using diagnostic criteria based on current best evidence (clinical examination, radiological examination and intra-articular block injection). Patient characteristics (gender (%), age (years), BMI (kg/m2)), results from the Hip Sports Activity Scale (HSAS), the SF-36, the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain distribution (pain manikin) were collected. Parametric and non-parametric statistics were used as appropriate for between-group analysis.

Results
Thirty-three (47%) patients, (30% women, 70% men, p < 0.01), were categorized as having hip-related groin pain. The hip-related groin pain group had a higher activity level during adolescence (p = 0.013), and a higher pre-injury activity level (p = 0.034), compared to the non-hip-related groin pain group. No differences (mean difference (95% CI)) between hip-related groin pain and non-hip-related groin pain were observed for age (0 (− 4; 4)), BMI (− 1.75 (− 3.61; 0.12)), any HAGOS subscales (p ≥ 0.318), any SF-36 subscales (p ≥ 0.142) or pain distribution (p ≥ 0.201).

Conclusions
Only half of the patients referred to tertiary care for long-standing hip and groin pain, who were predominantly men with a high activity level, had hip-related groin pain. Self-reported pain localization and distribution did not differ between patients with hip-related groin pain and those with non-hip-related groin pain, and both patient groups had poor perceived general health, and hip-related symptoms and function.

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References

53

[1]

Epidemiology of Muscle Injuries in Professional Football (Soccer)

Jan Ekstrand, Martin Hägglund, Markus Waldén

The American Journal of Sports Medicine 2011 10.1177/0363546510395879

[2]

Sedaghati P, Alizadeh MH, Shirzad E, Ardjmand A. Review of sport-induced groin injuries. Trauma monthly. 2013;18(3):107–12. 10.5812/traumamon.12666

[3]

Werner J, Hagglund M, Walden M, Ekstrand J. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med. 2009;43(13):1036–40. 10.1136/bjsm.2009.066944

[4]

Thorborg K, Rathleff MS, Petersen P, Branci S, Holmich P. Prevalence and severity of hip and groin pain in sub-elite male football: a cross-sectional cohort study of 695 players. Scand J Med Sci Sports. 2017;27(1):107–14. 10.1111/sms.12623

[5]

Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC (3)-study. Pain. 2003;102(1–2):167–78. 10.1016/s0304-3959(02)00372-x

[6]

Kemp JL, Makdissi M, Schache AG, Pritchard MG, Pollard TC, Crossley KM. Hip chondropathy at arthroscopy: prevalence and relationship to labral pathology, femoroacetabular impingement and patient-reported outcomes. Br J Sports Med. 2014;48(14):1102–7. 10.1136/bjsports-2013-093312

[7]

Hallen A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci. 2014;32(13):1229–36. 10.1080/02640414.2014.905695

[8]

Worner T, Sigurethsson HB, Palsson A, Kostogiannis I, Ageberg E. Worse self-reported outcomes but no limitations in performance-based measures in patients with long-standing hip and groin pain compared with healthy controls. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):101–7. 10.1007/s00167-016-4101-6

[9]

Holmich P, Thorborg K, Nyvold P, Klit J, Nielsen MB, Troelsen A. Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain? Outcome 10 years after baseline assessment. Br J Sports Med. 2014;48(16):1240-4. 10.1136/bjsports-2013-092478

[10]

Sansone M, Ahlden M, Jonasson P, Thomee R, Falk A, Sward L, et al. Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):786-92. 10.1007/s00167-013-2738-y

[11]

Doha agreement meeting on terminology and definitions in groin pain in athletes

Adam Weir, Peter Brukner, Eamonn Delahunt et al.

British Journal of Sports Medicine 2015 10.1136/bjsports-2015-094869

[12]

Bradshaw CJ, Bundy M, Falvey E. The diagnosis of longstanding groin pain: a prospective clinical cohort study. Br J Sports Med. 2008;42(10):851–4. 10.1136/bjsm.2007.039685

[13]

Predictors of Clinically Suspected Intra‐articular Hip Symptoms and Prevalence of Hip Pathomorphologies Presenting to Sports Medicine and Hip Preservation Orthopaedic Surgeons

Christopher M. Larson, Marc R. Safran, David A. Brcka et al.

Arthroscopy 2018 10.1016/j.arthro.2017.09.030

[14]

Agricola R, Heijboer MP, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH. Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis. 2013;72(6):918–23. 10.1136/annrheumdis-2012-201643

[15]

Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012–8. 10.1302/0301-620x.87b7.15203

[16]

Eijer H, Hogervorst T. Femoroacetabular impingement causes osteoarthritis of the hip by migration and micro-instability of the femoral head. Med Hypotheses. 2017;104:93–6. 10.1016/j.mehy.2017.05.035

[17]

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

D R Griffin, E J Dickenson, J O'Donnell et al.

British Journal of Sports Medicine 2016 10.1136/bjsports-2016-096743

[18]

Byrd JW, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;32(7):1668–74. 10.1177/0363546504266480

[19]

Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial

Damian R Griffin, Edward J Dickenson, Peter D H Wall et al.

The Lancet 2018 10.1016/s0140-6736(18)31202-9

[20]

Colvin AC, Harrast J, Harner C. Trends in hip arthroscopy. J Bone Joint Surg Am. 2012;94(4):e23. 10.2106/jbjs.j.01886

[21]

Cvetanovich GL, Chalmers PN, Levy DM, Mather RC 3rd, Harris JD, Bush-Joseph CA, et al. Hip arthroscopy surgical volume trends and 30-day postoperative complications. Arthroscopy. 2016;32(7):1286–92. 10.1016/j.arthro.2016.01.042

[22]

Kahlenberg CA, Han B, Patel RM, Deshmane PP, Terry MA. Time and cost of diagnosis for symptomatic Femoroacetabular impingement. Orthop J Sports Med. 2014;2(3):2325967114523916. 10.1177/2325967114523916

[23]

Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Souza RB, et al. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med. 2018;52(9):581–93. 10.1136/bjsports-2017-098264

[24]

Martin HD, Kelly BT, Leunig M, Philippon MJ, Clohisy JC, Martin RL, et al. The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. Arthroscopy. 2010;26(2):161–72. 10.1016/j.arthro.2009.07.015

[25]

A Systematic Approach to the Plain Radiographic Evaluation of the Young Adult Hip

John C. Clohisy, John C. Carlisle, Paul E. Beaulé et al.

The Journal of Bone & Joint Surgery 2008 10.2106/jbjs.h.00756

[26]

Mosler AB, Weir A, Serner A, Agricola R, Eirale C, Farooq A, et al. Musculoskeletal screening tests and bony hip morphology cannot identify male professional soccer players at risk of groin injuries: a 2-year prospective cohort study. Am J Sports Med. 2018. https://doi.org/10.1177/0363546518763373 . 10.1177/0363546518763373

[27]

Jacobson JA, Bedi A, Sekiya JK, Blankenbaker DG. Evaluation of the painful athletic hip: imaging options and imaging-guided injections. AJR Am J Roentgenol. 2012;199(3):516–24. 10.2214/ajr.12.8992

[28]

Thorborg K, Holmich P, Christensen R, Petersen J, Roos EM. The Copenhagen hip and groin outcome score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med. 2011;45(6):478–91. 10.1136/bjsm.2010.080937

[29]

Naal FD, Miozzari HH, Kelly BT, Magennis EM, Leunig M, Noetzli HP. The hip sports activity scale (HSAS) for patients with femoroacetabular impingement. Hip Int. 2013;23(2):204–11. 10.5301/hipint.5000006

[30]

Sullivan M, Karlsson J. The Swedish SF-36 health survey III. Evaluation of criterion-based validity: results from normative population. J Clin Epidemiol. 1998;51(11):1105–13. 10.1016/s0895-4356(98)00102-4

[31]

Sullivan M, Karlsson J, Ware JE Jr. The Swedish SF-36 health survey--I. evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995;41(10):1349–58. 10.1016/0277-9536(95)00125-q

[32]

Poulsen E, Overgaard S, Vestergaard JT, Christensen HW, Hartvigsen J. Pain distribution in primary care patients with hip osteoarthritis. Fam Pract. 2016;33(6):601–6. 10.1093/fampra/cmw071

[33]

Peters S, Laing A, Emerson C, Mutchler K, Joyce T, Thorborg K, et al. Surgical criteria for femoroacetabular impingement syndrome: a scoping review. Br J Sports Med. 2017;51(22):1605–10. 10.1136/bjsports-2016-096936

[34]

Frank JM, Harris JD, Erickson BJ, Slikker W 3rd, Bush-Joseph CA, Salata MJ, et al. Prevalence of Femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy. 2015;31(6):1199–204. 10.1016/j.arthro.2014.11.042

[35]

Gosvig KK, Jacobsen S, Sonne-Holm S, Gebuhr P. The prevalence of cam-type deformity of the hip joint: a survey of 4151 subjects of the Copenhagen osteoarthritis study. Acta Radiol. 2008;49(4):436–41. 10.1080/02841850801935567

[36]

Gerhardt MB, Romero AA, Silvers HJ, Harris DJ, Watanabe D, Mandelbaum BR. The prevalence of radiographic hip abnormalities in elite soccer players. Am J Sports Med. 2012;40(3):584–8. 10.1177/0363546511432711

[37]

Mosler AB, Crossley KM, Waarsing JH, Jomaah N, Weir A, Holmich P, et al. Ethnic differences in bony hip morphology in a cohort of 445 professional male soccer players. Am J Sports Med. 2016;44(11):2967–74. 10.1177/0363546516656163

[38]

Casartelli NC, Bizzini M, Maffiuletti NA, Sutter R, Pfirrmann CW, Leunig M, et al. Exercise therapy for the management of femoroacetabular impingement syndrome: preliminary results of clinical responsiveness. Arthritis Care Res. 2019;71(8):1074-83. 10.1002/acr.23728

[39]

Chaudhry H, Ayeni OR. The etiology of femoroacetabular impingement: what we know and what we don't. Sports health. 2014;6(2):157–61. 10.1177/1941738114521576

[40]

Wenger DR, Kishan S, Pring ME. Impingement and childhood hip disease. J Pediatr Orthop B. 2006;15(4):233–43. 10.1097/01202412-200607000-00001

[41]

The Development of Cam-Type Deformity in Adolescent and Young Male Soccer Players

Rintje Agricola, Johannes H.J.M. Bessems, Abida Z. Ginai et al.

The American Journal of Sports Medicine 2012 10.1177/0363546512438381

[42]

A Cam Deformity Is Gradually Acquired During Skeletal Maturation in Adolescent and Young Male Soccer Players

Rintje Agricola, Marinus P. Heijboer, Abida Z. Ginai et al.

The American Journal of Sports Medicine 2014 10.1177/0363546514524364

[43]

Philippon MJ, Ho CP, Briggs KK, Stull J, LaPrade RF. Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. 2013;41(6):1357–62. 10.1177/0363546513483448

[44]

The Cam-type Deformity of the Proximal Femur Arises in Childhood in Response to Vigorous Sporting Activity

K. A. Siebenrock, F. Ferner, P. C. Noble et al.

Clinical Orthopaedics and Related Research 2011 10.1007/s11999-011-1945-4

[45]

Quality of life impairments after hip arthroscopy in people with hip chondropathy

Stephanie R. Filbay, Joanne L. Kemp, Ilana N. Ackerman et al.

Journal of Hip Preservation Surgery 2016 10.1093/jhps/hnw005

[46]

Gignac MA, Davis AM, Hawker G, Wright JG, Mahomed N, Fortin PR, et al. "what do you expect? You're just getting older": a comparison of perceived osteoarthritis-related and aging-related health experiences in middle- and older-age adults. Arthritis Rheum. 2006;55(6):905–12. 10.1002/art.22338

[47]

Nisar A, Augustine A, Horrey L, Craig D, Meek R, Patil S. Psychosocial aspects of hip disease in the young adult. Hip Int. 2013;23(4):417–23. 10.5301/hipint.5000041

[48]

Flosadottir V, Roos EM, Ageberg E. Muscle function is associated with future patient-reported outcomes in young adults with ACL injury. BMJ Open Sport Exerc Med. 2016;2(1):e000154. 10.1136/bmjsem-2016-000154

[49]

Sakamoto J, Manabe Y, Oyamada J, Kataoka H, Nakano J, Saiki K, et al. Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients. Clin Anat. 2018;31(5):705-9. 10.1002/ca.23077

[50]

Sakamoto J, Morimoto Y, Ishii S, Nakano J, Manabe Y, Okita M, et al. Investigation and macroscopic anatomical study of referred pain in patients with hip disease. J Phys Ther Sci. 2014;26(2):203–8. 10.1589/jpts.26.203

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Published: Sep 14, 2019
Vol/Issue: 20(1)
License: View

Authors

Department of Health Sciences Division of Physical Therapy Lund University Lund Sweden; Department of Orthopedics Clinical Sciences Lund University Lund Sweden

Cite This Article

Anders Pålsson, Ioannis Kostogiannis, Håkan Lindvall, et al. (2019). Hip-related groin pain, patient characteristics and patient-reported outcomes in patients referred to tertiary care due to longstanding hip and groin pain: a cross-sectional study. BMC Musculoskeletal Disorders, 20(1). https://doi.org/10.1186/s12891-019-2794-7

Hip-related groin pain, patient characteristics and patient-reported outcomes in patients referred to tertiary care due to longstanding hip and groin pain: a cross-sectional study

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