Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology.

Area of Science:

• Orthopedic surgery
• Radiology
• Hip joint pathology

Background:

• Increasing incidence of patients with longstanding, non-arthritic hip pain.
• Untreated hip dysplasia, acetabular retroversion, and femoroacetabular impingement (FAI) can progress to osteoarthritis (OA).
• Challenges in selecting optimal treatment for non-arthritic hip pain.

Purpose of the Study:

• To categorize radiographic findings in patients with hip pain and suspected intra-articular pathology.
• To develop a treatment algorithm for allocating specific interventions based on clinical conditions.
• To guide decision-making for non-arthritic hip pain management.

Main Methods:

• Comprehensive literature review using Public Medline database.
• Searched MeSH terms and synonyms for FAI, acetabular retroversion, periacetabular osteotomy, and hip arthroscopy.
• Synthesized radiographic findings and treatment outcomes from existing studies.

Main Results:

• Identified radiographic signs for acetabular retroversion (crossover, posterior wall, ischial spine signs) and hip dysplasia (lateral CE-angle, acetabular index).
• Correlated Tönnis index with osteoarthritis progression and surgical outcomes.
• Differentiated treatment pathways: periacetabular osteotomy for total acetabular retroversion, hip arthroscopy for focal retroversion.

Conclusions:

• The developed treatment algorithm effectively utilizes radiographic findings for clinical decision-making.
• Aids in managing patients with longstanding hip pain and suspected intra-articular pathologies.
• Facilitates tailored treatment selection for hip dysplasia and FAI.