Those who treat adolescents with hip pain are no stranger to the complex and often puzzling array of non-specific presenting symptoms. For years, the management of hip pain was dictated by patient age. But what do you do when the patient is older than the classic “limping child,” yet too young to be concerned about osteoarthritis? Over the past few decades, our understanding of the causes of hip pain in young adults has increased dramatically. In their article entitled “Femoroacetabular Impingement in Pediatric Patients,” Sheppard et al. attempt to clarify some of the diagnostic challenges by providing clinicians with a comprehensive overview of an increasingly common diagnosis. However, we need to approach this diagnosis with caution. Medicine is just like anything else in today’s society: It is not immune to new “trendy” diagnoses. Over the last few decades, the pendulum swung from not even recognizing femoroacetabular impingement (FAI) as a diagnostic entity to FAI routinely being diagnosed from plain films and MRI alone. So the question must be asked: Is the explosion in diagnosis warranted, or are we over-diagnosing patients with FAI? While we don’t have an answer to this question yet, it is important to recognize that there are a wide variety of subtle abnormalities in the shape of the hip, ranging from hips that are too shallow (e.g. dysplastic) or hips that are too deep (e.g. FAI), that can cause pain, limit function, and ultimately lead to early degenerative disease.
So what should providers on the front lines do? Perhaps the most important message is that we need to identify and treat these “at-risk” pre-arthritic hips in order to prevent, or at least postpone, the need for a total hip replacement. The first step is to obtain good quality, standing X-rays and refer to a specialist if conservative measures do not resolve the symptoms. Even in circumstances where the radiographs are read as normal, there are subtle findings that may be identified by a specialist that will warrant further investigation or treatment.
