FP6.8 Symptom Patterns of Prearthritic Hip Conditions: A Comparison Between Hip Dysplasia, Acetabular Retroversion and Femoral Retrotorsion

Objectives: In hip preservation surgery, a more differentiated view of hip anomalies has developed in recent years. Despite this progress in conceptual understanding, the typical symptom patterns for hip dysplasia and Femoroacetabular Impingement (FAI) are often described only in past studies with small patient cohorts, which poses a risk of possible overgeneralization. Our study addresses this deficiency by aiming for a more detailed understanding of the symptoms of hip dysplasia, acetabular retroversion, and femoral torsion pathology through the analysis of subgroups and mixed forms.

Methods: In the context of a prospective survey, patients who underwent periacetabular osteotomy (PAO) at our clinic between 2022 and 2023 were examined. Preoperatively, specific symptoms and pain locations were recorded from the onset of symptoms. Patients were classified into six groups based on radiological parameters:

Group I: Hip Dysplasia

Group II: Hip Dysplasia + Acetabular Retroversion

Group III: Borderline Dysplasia

Group IV: Borderline Dysplasia + Acetabular Retroversion

Group V: Acetabular Retroversion

Group VI: Femoral Retrotorsion

Statistical analysis was conducted using the Kruskal-Wallis test followed by Dunn’s correction (GraphPad Prism 10.0.2). The study was approved by the clinical ethics committee, and all patients provided written consent.

Results: A total of 325 patients were enrolled: 117 were allocated to group I, 36 to group II, 75 to group III, 40 to group IV, 33 to group V and 24 to group VI. Analysis of symptom patterns showed that groin pain (mean = 71.61%, range = 66.67 - 75.76%) and lateral thigh pain (mean = 60.62%, range = 48.48 - 65%) were the predominant symptoms in all groups. However, subgroup analysis revealed significant differences in additional symptoms. Group I showed a significant correlation with low back pain, whereas group III showed a significant correlation with anterior thigh pain. Group IV showed significant correlations with lateral hip, lateral thigh and lower back pain. Group VI showed significant correlations with knee pain.

Conclusions: The study highlights that classical symptoms such as groin pain and lateral thigh pain are common in hip pathologies, but associated symptoms significantly differ among subgroups of various pre-arthritic deformities. Particularly, awareness of the identified negative correlations, meaning the presence of specific symptom combinations in the absence of the classical symptom presentation, is essential for an early clinical diagnosis.