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Hip pain is common in adults of all ages and activity levels. In nonelite adult soccer players, hip and groin injuries represent 28% to 45% of all injuries in women and 49% to 55% in men.1 The prevalence of the cam deformity (deformity of the femoral head) is 41% in nonelite male soccer players and 17% in male nonathletes.2 In adults older than 45 years, 6.7% to 9.7% have osteoarthritis of the hip, and one in four adults will develop symptomatic hip osteoarthritis in their lifetime.3 In the United States in 2009, hip replacements accounted for $13.7 billion in health care costs.3
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| If imaging is performed in the evaluation of a patient with undifferentiated chronic hip pain, standing anteroposterior hip and pelvic radiographs should be the first choice.4,21 | C | Expert opinion and consensus guidelines |
| For patients with anterior hip pain and history suggestive of a labral tear, stress fracture of the femoral neck, or early avascular necrosis, magnetic resonance imaging should be performed for accurate diagnosis.5,11,12,21–23 | C | Expert opinion and reviews of prospective and randomized trials |
| For intra-articular pain, ultrasound-guided anesthetic injection of the hip may be diagnostic, and corticosteroid injection may be therapeutic.30 | C | Clinical review and expert opinion |
| For patients with greater trochanteric pain syndrome not responding to conservative therapy, ultrasonography or magnetic resonance imaging should be considered to evaluate for gluteus medius tendon tears.15,16,21 | C | Clinical reviews and expert opinion |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to
Approach to Evaluation
Hip pain is often localized to one of three locations: anterior, lateral, or posterior (Figure 14). A focused history and physical examination can help differentiate the causes of hip pain (Table 1).2–20 Diagnosing the cause of hip pain is important for prescribing effective therapy.
FIGURE 1.Localization of hip pain. (A) Anterior view. (B) Posterior view.
Illustration by Todd Buck
Reprinted with permission from Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician. 2014;89(1):27–34.
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