Assessing risk factors for early hip osteoarthritis in activity-related hip pain: a Delphi study

Abstract

Objective: Hip pain and injury as a result of activity can lead to the development of early hip osteoarthritis (OA) in susceptible individuals. Our understanding of the factors that increase susceptibility continues to evolve. The ability to clearly identify individuals (and cohorts) with activity-related hip pain who are at risk of early hip OA is currently lacking. The purpose of this study was to gain expert consensus on which key clinical measures might help predict the risk of early hip OA in individuals presenting with activity-related hip pain. The agreed measures would constitute a standardised approach to initial clinical assessment to help identify these individuals.

Methods: This Dephi study used online surveys to gain concordance of expert opinion in a structured process of 'rounds'. In this study, we asked 'What outcome measures are useful in predicting hip OA in activity-related hip pain?' The Delphi panel consisted of experts from sport and exercise medicine, orthopaedics, rheumatology, physiotherapy and OA research.

Results: The study identified key clinical measures in the history, examination and investigations (plain anteroposterior radiograph and femoroacetabular impingement views) that the panel agreed would be useful in predicting future risk of hip OA when assessing activity-related hip pain. The panel also agreed that certain investigations and tests (eg, MR angiography) did not currently have a role in routine assessment. There was a lack of consensus regarding the role of MRI, patient-reported outcome measures (PROMs) and certain biomechanical and functional assessments.

Conclusions: We provide a standardised approach to the clinical assessment of patients with activity-related hip pain. Assessment measures rejected by the Delphi panel were newer, more expensive investigations that currently lack evidence. Assessment measures that did not reach consensus include MRI and PROMs. Their role remains ambiguous and would benefit from further research.

Keywords: RADIOLOGY & IMAGING; RHEUMATOLOGY; SPORTS MEDICINE.

Figure 1

Methodology overview (AP, anteroposterior; OA, osteoarthritis).

Figure 2

Delphi round 1 results (AP, anteroposterior; BMI, body mass index; EOR, end of range; FABER, flexion abduction and external rotation; FAI, femoroacetabular impingement; FH , family history; FMS, functional movement screen; HAGOS, Copenhagen Hip and Groin Score; HOOS, Hip Disability and Osteoarthritis Outcome Score; i-HOT, International Hip Outcome Tool; ITB, iliotibial band; OA, osteoarthritis; OCD, osteochondral defect; OHS, Oxford Hip Score; PMH, previous medical history; PROMs, patient-reported outcome measures; THR, total hip replacement; WOMAC, Western Ontario McMaster Universities Arthritis Index; VAS, visual analogue scale).

Figure 3

Overview of final Delphi results (AP, anteroposterior; BMI, body mass index; FABER, flexion abduction and external rotation; FADIR, flexion, adduction, internal rotation; FAI, femoroacetabular impingement; HAGOS, Copenhagen Hip and Groin Score; HOOS, Hip Disability and Osteoarthritis Outcome Score; i-HOT, International Hip Outcome Tool; IR, internal rotation; MRA, MR angiography; OA, osteoarthritis; OHS, Oxford Hip Score; PROMs, patient-reported outcome measures; ROM, range of motion; WOMAC, Western Ontario McMaster Universities Arthritis Index).