Prearthritic Hip Pain in the Young Adult


Increased recognition of structural hip deformities as predisposing causes of hip osteoarthritis has led to earlier and more aggressive nonarthroplasty surgical treatments in young adult patients with hip pain. The understanding of such predisposing hip pathomorphologic conditions as hip dysplasia and femoroacetabular impingement is rapidly evolving. Although dysplasia and femoroacetabular impingement constitute most of the structural hip problems seen in young adults, there exists a myriad of less frequent causes of hip pain. Physical examination of the young adult with hip pain is directed at reproducing pain and assessing range of motion. Tests specific to certain disorders are useful, and examination findings can direct imaging studies. Advanced imaging such as magnetic resonance arthrography or CT can further demonstrate underlying pathomorphology and associated chondrolabral damage. When nonsurgical management fails to provide adequate relief, arthroplasty or nonarthroplasty procedures may be deemed appropriate. This decision is based on patient age, activity level, degree of articular cartilage damage, and other factors. Older patients with more extensive damage are more appropriate candidates for arthroplasty, whereas younger patients (<45 years of age) may be better suited for hip preservation surgery. Postoperative rehabilitation is specific to the intervention, and protocols are not currently standardized.

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