Imaging for hip-related groin pain: don't be hip-notised by the findings

Awareness of femoroacetabular impingement (FAI) syndrome, acetabular labral tears and chondral lesions as potential causes of hip-related groin pain has increased considerably due to advances in imaging and arthroscopic surgery. Consequently, hip imaging and surgery rates have grown rapidly.1 However, there is no strong evidence of improved clinical outcomes with arthroscopic interventions. Although imaging findings are only diagnostic for FAI syndrome when they exist together with clinical signs and symptoms , imaging remains the main criterion for FAI surgery.2 Most patients (71%) are willing to undergo surgery based solely on their physician’s recommendation.3 We question whether such reliance on imaging can be justified. Does it have risks (eg, radiation, downstream testing, costs) and may it lead to suboptimal management of hip-related groin pain? People with both large cam morphology and reduced hip internal rotation are 25 times more likely to develop future hip osteoarthritis (OA).4 While such high odd ratios cannot be ignored, many with such morphology do not develop …