Hip Radiograph Findings in Patients Aged 40 Years and Under with Posterior Pelvic Pain

PM R. 2019 Aug:11 Suppl 1:S46-S53. doi: 10.1002/pmrj.12180. Epub 2019 Jul 25.


Background: Several sacroiliac joint (SIJ) provocative tests used to assess posterior pelvic pain involve moving and stressing the hip. It is unknown if there is a subgroup of patients with posterior pelvic pain who have underlying hip deformity that could potentially influence performance and interpretation of these tests.

Objective: To describe the prevalence of radiographic hip deformity and hip osteoarthritis in a group of adults 40 years old and under who met the clinical diagnostic criteria for treatment of posterior pelvic pain with an image guided intra-articular SIJ injection.

Design: Retrospective cohort study.

Setting: Tertiary university orthopedic department PATIENTS (OR PARTICIPANTS): One hundred and forty-eight patients were evaluated (83% (123/148) female; mean age 31.3 ± 6.2 years). All had completed a trial of comprehensive noninvasive treatment for posterior pelvic pain and had a minimum of three positive SIJ provocative tests on physical examination.

Methods: Retrospective review identified patients undergoing SIJ injection for pain recommended and performed by seven physiatrists between 2011 and 2017. Hip radiographs were read by a physician with expertise in hip measurements with previously demonstrated excellent intrarater reliability.

Main outcome measurements: Percentage of patients with hip deformity findings.

Results: No patients meeting the inclusion criteria had significant radiographic hip osteoarthritis (Tonnis ≥2 indicating moderate or greater radiographic hip osteoarthritis) and 4/148 (3%) were found to have mild radiographic hip osteoarthritis. Prearthritic hip disorders were identified in 123 (83%, 95% CI: 76, 89%) patients. For those patients with prearthritic hip disorders, measurements consistent with femoroacetabular impingement (FAI) were seen in 61 (41%) patients, acetabular dysplasia in 49 (33%) patients, and acetabular retroversion in 85 (57%) patients. Acetabular retroversion was identified in 43% (crossover sign) and 39% (prominent ischial spine) of patients.

Conclusions: Approximately 57% of adult patients under the age of 40 years with the clinical symptom complex of SIJ pain were found to have radiographic acetabular retroversion. This is a higher percentage than the 5%-15% found in asymptomatic people in the current literature. Further study is needed to assess links between hip structure, hip motion, and links to pelvic pain including peri and intra-articular SIJ pain.

Level of evidence: III.

MeSH terms

  • Acetabulum
  • Adult
  • Age Factors
  • Bone Retroversion / epidemiology*
  • Female
  • Femoracetabular Impingement / epidemiology*
  • Hip Dislocation / epidemiology*
  • Humans
  • Male
  • Osteoarthritis, Hip / epidemiology*
  • Pelvic Pain / diagnostic imaging*
  • Pelvic Pain / etiology
  • Prevalence
  • Retrospective Studies
  • Sacroiliac Joint