title: Early intra-articular hip disease presenting with posterior pelvic and groin pain.
abstract: OBJECTIVE
  To determine whether posterior pelvic pain is associated with intra-articular hip abnormalities (labral tears and early degenerative changes) in patients with minimal-to-no radiographic abnormalities.
  
  
  METHODS
  A retrospective observational study of prospectively collected data collected from patients with an arthroscopy-confirmed diagnosis of acetabular labral tear or femoral and/or acetabular chondrosis, without severe deformity.
  
  
  METHODS
  An academic orthopedic clinic at a tertiary hospital.
  
  
  METHODS
  All patients, having failed to respond to conservative treatment, required surgical intervention for definitive structural diagnosis and treatment because of pain and dysfunction. Within this group, patients with posterior pelvic pain were included. One hundred thirty consecutive patients, 93 women and 37 men with mean age 31.16 years (range, 10-65.5 years), entered the study, and observational findings were reported.
  
  
  METHODS
  University instructional review board approval was obtained before conducting the study. Patients completed medical information questionnaires, pain diagrams, severity of pain, and validated hip questionnaires that focused on symptoms and function. Postoperatively, patients who had posterior pelvic pain before surgery completed a phone interview regarding their clinical progress. MAIN OUTCOMES MEASUREMENT: A numeric pain scale, description of location of continued pain, Modified Harris Hip Score, and satisfaction with the procedure were recorded.
  
  
  RESULTS
  Twenty-six (20%) of the 130 patients complained of posterior pelvic pain as a component of their clinical presentation. Of these patients, the mean duration of symptoms was 29.5 months. A total of 92% related that their pain was moderate or marked. The preoperative mean modified Harris Hip Score was 61.6 (range, 27-85) and showed postoperative improvement with a mean of 84.5 (range, 45-100; P < .001). The Modified Harris Hip Score was completed a mean 15.9 months postoperatively. Pain diagrams and questionnaires revealed that of the 26 patients with posterior pelvic pain, 92.3% (24/26) also had associated groin pain (P < .001), 57.7% (15/26) had lateral thigh pain, and 7.7% (2/26) had anterior thigh pain (P < .001). A total of 12 of 26 patients with an initial presentation including posterior pelvic pain agreed to a phone interview. The mean time after surgery in this group of patients was 56.9 months (range, 39-65 months). Five of 12 patients reported no pain and no activity limitations. The Visual Analog Scale representing their self-reported average daily pain was 1.4 (range, 0-3). The mean Modified Harris Hip Score was 10.4 (range, 8-13). All 7 patients with continued pain described the pain in more than one location. Ten of 12 patients were very satisfied with hip arthroscopy, 1 of 12 was somewhat satisfied, and 1 of 12 was dissatisfied. This latter patient went on to have total hip arthroplasty and was very satisfied with that procedure. All 12 patients would recommend the procedure to a friend.
  
  
  CONCLUSIONS
  Twenty percent of patients at the authors' institution who required surgical intervention to treat their pain after not responding to conservative management had posterior pelvic pain in addition to groin or lateral and anterior hip pain. Of those respondents, 33% had complete resolution of symptoms at 4.75 years after surgery, and all had reduction in pain as compared with completion of conservative care. Patients with early intra-articular hip pathology, such as acetabular labral tears with no or mild hip deformity, and patients with arthrosis and mild hip deformity may experience groin and posterior pelvic pain as part of their clinical presentation.
authors.affiliation: Section, Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Washington University School of Medicine, One Barnes Plaza, Suite 11300, St Louis, MO 64110, USA. pratherh@wustl.edu
authors.forename: Heidi
authors.initials: H
authors.lastname: Prather
authors.forename: Devyani
authors.initials: D
authors.lastname: Hunt
authors.forename: Anne
authors.initials: A
authors.lastname: Fournie
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
mesh_terms: D000077:Acetabulum / Q000002:abnormalities* / Q000293:injuries / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries; D002648:Child; D005260:Female; D006621:Hip Joint / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D053591:Referred Pain / Q000175:diagnosis*; D017699:Pelvic Pain / Q000209:etiology*; D010808:Physical Examination; D012189:Retrospective Studies; D055815:Young Adult