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Imaging for hip-related groin pain: don’t be hip-notised by the findings
  1. Kieran O’Sullivan1,2,
  2. Ben Darlow3,
  3. Peter O’Sullivan4,
  4. Bruce B Forster5,
  5. Michael P Reiman6,
  6. Adam Weir7,8
  1. 1 Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Department of Clinical Therapies, University of Limerick, Limerick, Ireland
  3. 3 Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
  4. 4 School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
  5. 5 Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
  6. 6 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
  7. 7 Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  8. 8 Erasmus MC Center for Groin Injuries, University Hospital Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Kieran O’Sullivan, Sports Spine Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; kieran.osullivan{at}

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Awareness of femoroacetabular impingement (FAI) syndrome, acetabular labral tears and chondral lesions as potential causes of hip-related groin pain has increased considerably due to advances in imaging and arthroscopic surgery. Consequently, hip imaging and surgery rates have grown rapidly.1 However, there is no strong evidence of improved clinical outcomes with arthroscopic interventions. Although imaging findings are only diagnostic for FAI syndrome when they exist together with clinical signs and symptoms, imaging remains the main criterion for FAI surgery.2 Most patients (71%) are willing to undergo surgery based solely on their physician’s recommendation.3 We question whether such reliance on imaging can be justified. Does it have risks (eg, radiation, downstream testing, costs) and may it lead to suboptimal management of hip-related groin pain?

Do imaging findings predict hip-related groin pain?

People with both large cam morphology and reduced hip internal rotation are 25 times more likely to develop future hip osteoarthritis (OA).4 While such high odd ratios cannot be ignored, many with such morphology do not develop …

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  • Twitter @kieranosull, @peteosullPT, @mikereiman, @brucebforster, @adamweirsports

  • Contributors All authors contributed substantially to this submission led by KOS and AW.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.