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Am J Sports Med. 2014 Apr;42(4):793-7. doi: 10.1177/0363546513518417. Epub 2014 Jan 30.

Incidence of hip pain in a prospective cohort of asymptomatic volunteers: is the cam deformity a risk factor for hip pain?

Author information

1
Paul E. Beaulé, Division of Orthopedic Surgery, University of Ottawa, 501 Smyth Road, CCW 1646, Ottawa, ON, Canada K1H 8L6. pbeaule@ottawahospital.on.ca.

Abstract

BACKGROUND:

Although cam-type femoroacetabular impingement is commonly associated with labral chondral damage and hip pain, a large proportion of asymptomatic individuals will have this deformity.

PURPOSE:

To determine the incidence of hip pain in a prospective cohort of volunteers who had undergone magnetic resonance imaging (MRI) of their hips.

STUDY DESIGN:

Case control study; Level of evidence, 3.

METHODS:

A total of 200 asymptomatic volunteers who underwent an MRI of both hips were followed for a mean time of 4.4 years (range, 4.01-4.95 years). Thirty were lost to follow-up, leaving 170 individuals (77 males, 93 females) with a mean age of 29.5 years (range, 25.7-54.5 years). All patients were blinded to the results of their MRI. All completed a follow-up questionnaire inquiring about the presence of hip pain or a history of hip pain lasting longer than 6 weeks since the original MRI. Each patient was asked to draw where the pain was on a body diagram.

RESULTS:

Eleven patients (5 males, 6 females; 6.5% of sample; mean age, 29.9 years; range, 25.7-45.6 years) reported hip pain, of which 3 (1 male, 2 females) had bilateral pain for a total of 14 hips. Seven of the 14 painful hips had a cam-type deformity at the time of the initial MRI versus 37 of the 318 nonpainful hips (P = .0002). This gave a relative risk of 4.3 (95% confidence interval [CI], 2.3-7.8) of developing hip pain if cam deformity was present. Those 14 painful hips had a significantly greater alpha angle at the radial 1:30 clock position than did those who did not develop pain with a cam deformity: 61.5° (range, 57.3°-65.7°) versus 57.9° (range, 56.9°-59.1°), respectively (P = .05). A significantly greater proportion of patients (12%) with limited internal rotation ≤20° (versus 2.7% with internal rotation >20°) went on to develop hip pain (P = .009; relative risk = 3.1 [95% CI, 1.6-6.0]).

CONCLUSION:

The presence of a cam deformity represents a significant risk factor for the development of hip pain. An elevated alpha angle at the 1:30 clock position and decreased internal rotation are associated with an increased risk of developing hip pain. However, not all patients with a cam deformity develop hip pain, and further research is needed to better define those at greater risk of developing degenerative symptoms.

KEYWORDS:

cam; hip deformity; internal rotation; pain

PMID:
24481825
DOI:
10.1177/0363546513518417
[Indexed for MEDLINE]

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