BACKGROUND Patients with symptomatic femoroacetabular impingement (FAI) typically have anterior groin pain. However, a subset of these patients may have pain located laterally, posteriorly, or in a combination of locations around the hip. PURPOSE To report and compare outcomes of hip arthroscopy for patients with FAI and atypical hip pain versus classic anterior groin pain. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Consecutive patients undergoing hip arthroscopy for FAI between August 2011 and March 2013 were identified. A total of 258 patients were identified as having symptomatic FAI based on clinical, radiographic, and advanced imaging diagnosis of FAI. Exclusion criteria included isolated thigh, knee, or low back pain. We also excluded patients with hip abductor pathology and trochanteric bursitis. Of the 226 patients ultimately included, 159 (70.4%) reported anterior groin pain, while 67 (29.6%) reported isolated lateral or posterior hip pain or a combination of locations. Patients were categorized into 4 groups: isolated anterior groin pain, lateral hip pain, posterior hip pain, and multiple primary hip pain locations (combined). These patients were followed prospectively with a minimum follow-up of 2 years. Patient characteristics, surgical characteristics, modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), revision hip arthroscopy, and conversions to total hip arthroplasty (THA) were recorded. RESULTS All 226 patients were included at final follow-up. Hip arthroscopy was performed by a single sports medicine fellowship-trained orthopaedic surgeon. Preoperative patient characteristics and baseline functional outcome scores did not significantly differ among groups. All 4 groups showed statistically significant improvements in mHHS and NAHS from baseline to final follow-up of a mean 2.63 years (range, 2.01-3.23 years). Functional outcome scores and rates of revision hip arthroscopy or conversion to THA did not significantly differ between groups. CONCLUSION Hip arthroscopy can effectively improve patient outcomes in atypical hip pain. A careful history and physical examination should identify this clinically meaningful subset of patients with FAI who can benefit from surgical intervention while identifying patients with concomitant posterior extra-articular hip or spine pathology that should be addressed appropriately.

中文翻译：

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髋臼髋臼撞击中的非典型髋痛：基于主要髋痛位置的结果比较。

背景技术有症状的股骨髋臼撞击（FAI）患者通常会出现前腹股沟疼痛。但是，这些患者中的一部分可能会出现横向，后侧或髋关节周围位置组合的疼痛。目的报告和比较FAI和非典型性髋部疼痛与经典腹股沟疼痛患者的髋关节镜检查结果。研究设计队列研究；证据级别，方法2。方法确定了2011年8月至2013年3月期间接受髋关节镜检查进行FAI的连续患者。根据FAI的临床，影像学和高级影像学诊断，共鉴定出258例有症状的FAI。排除标准包括孤立的大腿，膝盖或腰背痛。我们还排除了髋关节外展病理和转子粗滑囊炎的患者。在最终纳入的226例患者中，有159例（70.4％）报告了前腹股沟痛，而67例（29.6％）报告了孤立的外侧或后部髋部疼痛或部位组合。将患者分为4组：孤立的前腹股沟痛，外侧髋部疼痛，后部髋部疼痛和多个原发性髋部疼痛部位（合并）。对这些患者进行前瞻性随访，至少随访2年。记录患者的特征，手术特征，改良的Harris髋关节评分（mHHS），非关节炎性髋关节评分（NAHS），髋关节镜翻修术以及向全髋关节置换术（THA）的转换。结果所有226例患者均被纳入最终随访。髋关节镜检查是由一名接受过运动医学研究金培训的骨科医生完成的。两组之间的术前患者特征和基线功能结局评分无显着差异。从基线到平均平均随访时间为2.63年（范围2.01-3.23年），所有4组患者的mHHS和NAHS均具有统计学上的显着改善。各组之间功能结局评分和翻修髋关节镜或转换为THA的比率无显着差异。结论髋关节镜检查可有效改善非典型髋痛患者的预后。仔细的病史和体格检查应确定该FAI患者具有临床意义的子集，这些患者可以从外科手术中受益，同时确定应适当解决的伴有关节后后髋关节或脊柱病理的患者。从基线到平均平均随访时间为2.63年（范围2.01-3.23年），所有4组患者的mHHS和NAHS均具有统计学上的显着改善。各组之间功能结局评分和翻修髋关节镜或转换为THA的比率无显着差异。结论髋关节镜检查可有效改善非典型髋痛患者的预后。仔细的病史和体格检查应确定该FAI患者具有临床意义的子集，这些患者可以从外科手术中受益，同时确定应适当解决的伴有关节后后髋关节或脊柱病理的患者。从基线到平均平均随访时间为2.63年（范围2.01-3.23年），所有4组患者的mHHS和NAHS均具有统计学上的显着改善。各组之间功能结局评分和翻修髋关节镜或转换为THA的比率无显着差异。结论髋关节镜检查可有效改善非典型髋痛患者的预后。仔细的病史和体格检查应确定该FAI患者具有临床意义的子集，这些患者可以从外科手术中受益，同时确定应适当解决的伴有关节后后髋关节或脊柱病理的患者。各组之间功能结局评分和翻修髋关节镜或转换为THA的比率无显着差异。结论髋关节镜检查可有效改善非典型髋痛患者的预后。仔细的病史和体格检查应确定该FAI患者具有临床意义的子集，这些患者可以从外科手术中受益，同时确定应适当解决的伴有关节后后髋关节或脊柱病理的患者。各组之间功能结局评分和翻修髋关节镜或转换为THA的比率无显着差异。结论髋关节镜检查可有效改善非典型髋痛患者的预后。仔细的病史和体格检查应确定该FAI患者具有临床意义的子集，这些患者可以从外科手术中受益，同时确定应适当解决的伴有关节后后髋关节或脊柱病理的患者。