There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion–adduction–internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head–neck radiographs are the initial diagnostic imaging of choice—advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.

中文翻译：

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2018 年苏黎世国际髋关节相关疼痛研究网络中青年和中年活跃成人髋关节相关疼痛分类、定义和诊断标准的共识建议

关于如何分类、定义或诊断与髋部相关的疼痛——这是年轻和中年活跃的成年人髋部和腹股沟疼痛的常见原因，尚无一致意见。这使临床医生和研究人员的工作复杂化。国际髋关节相关疼痛研究网络共识小组于 2018 年 11 月在苏黎世召开会议，旨在就如何对以髋关节相关疼痛为主要症状的中青年活跃成人的髋关节疾病进行分类、定义和诊断提出建议。在会议之前，我们于 2018 年 6 月对电子数据库进行了范围界定审查，以确定出现髋部相关疼痛的年轻和中年活跃成年人的髋部疾病的定义、流行病学和诊断。我们针对这些制定并提交了基于证据的声明，供 37 位专家组成的小组讨论并达成共识。在诊断中青年髋关节相关疼痛时，应排除非肌肉骨骼和严重的髋关节病理状况（如肿瘤、感染、应力性骨折、股骨头骨骺滑脱）以及竞争性肌肉骨骼疾病（如腰椎） -年龄活跃的成年人。出现髋关节相关疼痛的年轻和中年活跃成年人中最常见的髋关节疾病是：(1) 股骨髋臼撞击症 (FAI) 综合征，(2) 髋臼发育不良和/或髋关节不稳定，以及 (3) 没有明显症状的其他疾病骨形态（盂唇、软骨和/或圆韧带状况），并且这些术语用于研究和临床实践。临床检查和诊断成像的诊断效用有限；因此，必须采取综合办法。屈曲-内收-内旋试验阴性有助于排除髋关节相关疼痛，尽管其临床应用有限。骨盆前后位和股骨头颈侧位 X 光片是首选的初始诊断影像——仅当需要额外的骨或软组织形态学细节时（例如，为了明确诊断、研究环境或计划手术），才应进行高级影像学检查。我们建议在研究中采用清晰、详细和一致的骨形态结果测量方法（定义、测量和统计报告）。未来以髋关节相关疼痛为主要症状的研究应包括对病因和预后的高质量前瞻性研究。表现出髋部相关疼痛的活跃成年人中最常见的髋部状况是：(1) FAI 综合征，(2) 髋臼发育不良和/或髋关节不稳定和 (3) 其他没有明显骨形态的疾病，包括盂唇、软骨和/或圆韧带疾病。最后一类不应与无症状人群中盂唇、软骨和/或圆韧带病理的偶然影像学发现混淆。未来的研究应该通过确定前瞻性研究中临床检查和诊断成像的临床效用来完善我们当前的建议。