Practice Practice Pointer

An approach to hip pain in a young adult

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1086 (Published 19 April 2018) Cite this as: BMJ 2018;361:k1086
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Diagnosing young adults with hip pain

An approach

  1. Alastair G Dick, specialist registrar in trauma and orthopaedics1,
  2. Jonathan M Houghton, consultant in sports medicine and rheumatology2,
  3. Marcus J K Bankes, consultant in trauma and orthopaedics1
  1. 1Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Fortius Clinic, London, UK
  1. Correspondence to A G Dick alastair.dick{at}nhs.net

What you need to know

  • Initial management of hip pain in young adults includes simple analgesics or non-steroidal anti-inflammatory medication (NSAIDs), activity modification, and an anteroposterior radiograph of the hip

  • Refer young adults with persistent hip pain for orthopaedic/sports and exercise medicine specialist opinion, even if imaging studies in primary care are reported as normal

  • Most common causes of persistent hip pain in young adults are femoroacetabular impingement syndrome (FAI), hip dysplasia, and early osteoarthritis

  • Early referral and treatment can improve pain and function but might also enable joint preserving treatments before the onset of osteoarthritis

  • Appropriate surgical correction of the anatomical abnormalities in FAI and dysplasia safely and reliably reduces pain and improves function; failure of these procedures usually reflects failure to identify pre-existing arthritic change in the joint or to correct the anatomical deformity

Hip pain in young adults is not normal and can be severe and disabling, affecting work, parenting, and leisure activities.12 The causes of hip pain in young adults (aged 16-50) tend to receive less attention than those in children (including Perthes’ disease, slipped capital femoral epiphysis, and septic arthritis) and in older patients (usually osteoarthritis). Imaging studies might not reveal an underlying problem, even where the patient’s symptoms are a consequence of clinically significant pathology.

Research has improved understanding of the causes of hip pain in young adults, including femoroacetabular impingement syndrome (FAI) and dysplasia of the hip, and has identified new treatments, although evidence is still limited.34 Importantly, both FAI and hip dysplasia are treatable causes of hip pain in young adults.456 This Practice Pointer aims to help the non-specialist evaluate young adults presenting with hip pain, and provides an update on common young adult hip pathologies.

How do patients present?

Hip problems in young adults can be considered as problems within the joint itself …

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