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Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018
  1. Michael P Reiman1,
  2. Rintje Agricola2,
  3. Joanne L Kemp3,
  4. Joshua J Heerey3,
  5. Adam Weir4,5,
  6. Pim van Klij2,
  7. Ara Kassarjian6,7,
  8. Andrea Britt Mosler3,
  9. Eva Ageberg8,
  10. Per Hölmich9,
  11. Kristian Marstrand Warholm10,
  12. Damian Griffin11,12,
  13. Sue Mayes3,
  14. Karim M Khan13,
  15. Kay M Crossley3,
  16. Mario Bizzini14,
  17. Nancy Bloom15,
  18. Nicola C Casartelli16,17,
  19. Laura E Diamond18,
  20. Stephanie Di Stasi19,
  21. Michael Drew20,21,
  22. Daniel J Friedman22,
  23. Matthew Freke23,
  24. Boris Gojanovic24,25,
  25. Sion Glyn-Jones26,
  26. Marcie Harris-Hayes15,
  27. Michael A Hunt27,
  28. Franco M Impellizzeri28,
  29. Lasse Ishøi9,
  30. Denise M Jones3,
  31. Matthew G King3,
  32. Peter R Lawrenson29,
  33. Michael Leunig30,
  34. Cara L Lewis31,
  35. Nicolas Mathieu32,
  36. Håvard Moksnes33,
  37. May-Arna Risberg34,35,
  38. Mark James Scholes3,
  39. Adam I Semciw3,
  40. Andreas Serner36,
  41. Kristian Thorborg9,
  42. Tobias Wörner37,
  43. Hendrik Paulus Dijkstra36,38
  1. 1Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
  2. 2Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
  3. 3La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
  4. 4Orthopaedics, Erasmus MC Center for Groin Injuries, Rotterdam, The Netherlands
  5. 5Sports Groin Pain Centre, Aspetar Hospital, Doha, Qatar
  6. 6Elite Sports Imaging SL, Madrid, Spain
  7. 7Musculoskeletal Radiology, Corades, LLC, Brookline, MA, United States
  8. 8Sport Sciences, Deparment of Health Sciences, Lund University, Lund, Sweden
  9. 9Sports Orthopaedic Research Center–Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  10. 10Oslo University Hospital, Oslo, Norway
  11. 11Orthopaedics - Medical School, University of Warwick, Coventry, UK
  12. 12Warwick Medical School, University of Warwick, Coventry, UK
  13. 13Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
  14. 14Research, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
  15. 15Physical Therapy, Washington University, St. Louis, Missouri, USA
  16. 16Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
  17. 17Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
  18. 18Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland Griffith University, Schoold of Allied Health Sciences, Griffith, Queensland, Australia
  19. 19School of Health and Rehabilitation Sciences, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  20. 20Athlete Availability, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
  21. 21Research into Sport and Exercise, University of Canberra, Canberra, Bruce, Australian Capital Territory, Australia
  22. 22Alfred Health, Melbourne, Victoria, Australia
  23. 23School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
  24. 24Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland
  25. 25Sports Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  26. 26Department of Orthopaedic Surgery, University of Oxford, Institute of Musculoskeletal Sciences, Oxford, United Kingdom
  27. 27Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
  28. 28Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  29. 29School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
  30. 30Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
  31. 31Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
  32. 32Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Loeche-les-Bains, Valais, Switzerland
  33. 33Oslo Sports Trauma Research Center, Oslo, Norway
  34. 34Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
  35. 35Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  36. 36Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  37. 37Department of Health Sciences, Lund University, Lund, Sweden
  38. 38Weill Cornell Medicine, Doha, Qatar
  1. Correspondence to Dr Michael P Reiman, Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA; reiman.michael{at}gmail.com

Abstract

There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion–adduction–internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head–neck radiographs are the initial diagnostic imaging of choice—advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.

  • hip
  • examination
  • consensus
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Footnotes

  • Twitter @MikeReiman, @RintjeAgricola, @JoanneLKemp, @JHeerey, @pimvklij, @akassarjian, @AndreaBMosler, @EvaAgeberg, @DamianGriffin, @NicCasartelli, @lauradiamond05, @S_DiStasi, @_mickdrew, @ddfriedman, @drsportsante, @MHarrisHayes, @francoimpell, @LasseIshoei, @mattgmking1, @PeteLawrenson, @ProfCaraLewis, @HMoksnes, @MarkScholes85, @ASemciw, @aserner, @KThorborg, @Wuninho, @DrPaulDijkstra

  • Contributors The concept was developed by JLK, ABM, KMC, KMK, CLL and MB. All authors contributed to the material presented and approved the final version of the manuscript. All authors contributed to the consensus voting and approval of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information

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