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

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.

Keywords: Groin; Hip joint; Pain; Patient reported outcomes; Prevalence.

Fig. 1

Flow chart of the recruitment process

Fig. 2

a-e. Passive hip ROM in flexion (a), medial rotation (b), lateral rotation (c), abduction (d) and extension (e)

Fig. 3

a-f. Hip impingement tests: AIMT (a) The examiner brings the hip into 90° flexion and then moves the hip into medial rotation and adduction. FADIR (b) The examiner brings the hip into maximal flexion, medial rotation and adduction. FABER (c) the examined leg is placed with the foot just proximal to the contralateral knee joint and the hip is brought into a combined flexion, abduction and external rotation. The examiner places a hand on the contralateral side of the pelvis to minimize pelvic rotation. DEXRIT (d) and DIRIT (e) the patient is asked to hold the contralateral hip in more than 90° flexion. The examiner then brings the hip into approximately 90° flexion and moves the hip through a wide arc of extension, abduction and external rotation (DEXRIT) or extension, adduction and internal rotation (DIRIT). PRIMT (f) supine position with the patient lying at the edge of the examining table. Both hips are brought into flexion and the patient is instructed to keep the contralateral hip in flexion while the examined hip is brought into extension, abduction and lateral rotation

Fig. 4

Pain distribution in percent (%) and 95% confidence interval of the different areas for all patients (n = 80), patients with hip-related groin pain (n = 33), and patients with non-hip-related groin pain (n = 36). Missing data, n = 1 (did no fill in)

Fig. 5

Activity level during adolescence, pre-injury and current activity level in terms of HSAS score with median, first and third quartile and range for all patients (n = 72). Missing data, n = 9 (did no fill in)

Fig. 6

Activity level during adolescence, pre-injury and current activity level in terms of HSAS score with median, first and third quartile and range for patients with hip-related groin pain (n = 30), and patients with non-hip-related groin pain (n = 32). Missing data, n = 8 (did no fill in)

Fig. 7

HAGOS score for all patients (n = 72), patients with hip-related groin pain (n = 30), and patients with non-hip-related groin pain (n = 32). Missing data, n = 9 (did no fill in). Normative data was extracted from Wörner et al. (n = 19) (54)

Fig. 8

SF-36 mean score and 95% confidence interval for all patients (n = 72), patients with hip-related groin pain (n = 30), and patients with non-hip-related groin pain (n = 32). Missing data, n = 9 (did no fill in). Normative data was extracted from Sullivan et al. (n = 5140) [30]