Understanding hip pathology in ballet dancers

Abstract

Purpose: The literature on hip injuries in ballet dancers was systematically evaluated to answer (1) whether the prevalence of morphological abnormalities and pathology of hip injuries in dancers differs from the general population (2) if there are any specific risk factors which contribute to a higher rate of hip injury and (3) what are the outcomes of primary and secondary intervention strategies.

Methods: A systematic literature search of Medline, EMBASE and the Cochrane Library was undertaken for all literature relating to hip injuries in ballet dancers using the PRISMA guidelines. Reference lists were also searched for relevant literature. Clinical outcome studies, prospective/retrospective case series published between 1989 and October 2021 were included. Review articles (non-original data), case reports, studies on animals as well as book chapters were excluded.

Results: The search yielded 445 studies, of which 35 were included for final analyses after screening. This included 1655 participants, of which 1131 were females. The analyses revealed that damage at the chondrolabral junction and degenerative disease of the hip may develop at a higher rate in ballet dancers than in the general population (odds ratio > 1 in 15/18 cohorts). The intra-articular lesions were more frequently found in postero-superior region of the hip suggesting an alternative impingement mechanism. Furthermore, numerous risk factors specific for hip injury in ballet were highlighted amidst a wide body of literature which consistently reports risk factors for a more generic 'dancer vulnerability'.

Conclusion: Ballet dancers may suffer from both higher rates of chondrolabral damage and degenerative disease in their hips. In contrast to other sports, the intra-articular lesions are more frequently found in postero-superior region of the hip. Future research clarifying the prevalence of osseous abnormalities and prevention strategies in dancers may be pivotal in delaying the development of hip disease in this cohort.

Level of evidence: Level IV.

Keywords: Ballet; Dancer; Dysplasia; FAI; Hip; Injury; Outcomes.; Pathology; Prevalence.

Fig. 1

The search processes

Fig. 2

The prevalence of hips with damage at the chondrolabral junction (including articular lesions and labral tears). Odds ratio and confidence interval values for individual studies given by comparing these values with those in the general population. Prevalence measured a per hip and b per person. Chondrolabral damage at the hip joint seems to occur at a higher rate in ballet dancers than in the general population

Fig. 3

The prevalence of degenerative disease of the hip in ballet. Odds ratio and confidence interval values for individual studies given by comparing these values with those in the general population. Prevalence measured a per hip and b per person. Degenerative disease at the hip joint seems to occur at a higher rate in ballet dancers than in the general population

Fig. 4

a The prevalence of osseous abnormalities in ballet dancers’ hips. Odds ratio and confidence interval values of individual studies given by comparing these values with those of the general population. Prevalence measured a per hip and b per person. Osseous abnormalities at the hip joint occurs at a similar rate in ballet dancers than in the general population

Fig. 5

Schematic diagram indicating the postero-superior impingement identified across four studies. Red: this area represents the position of cartilage damage reported by Duthon et al., Kolo et al., and Charbonnier et al., Green: this area represents peak compression forces identified by Assassi and Thalman using in silico modelling of ballet hip movements. Blue: this area represents the location of impingements modelled to occur in extremes of motion achieved in ballet by Charbonnier et al. and Assassi and Thalman