Do psychological factors or radiographic severity play a role in the age of onset in symptomatic developmental dysplasia of hip and femoroacetabular impingement syndrome?

Abstract

Background Age of onset in symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement syndrome (FAIS) varies. The purpose of this study was to investigate whether psychological factors, radiographic, and clinical variables were related to age of onset of hip pain in DDH and FAIS. Methods We collected demographic, clinical, and radiographic data on 56 DDH and 84 FAIS patients. Each was diagnosed based on radiographic findings and clinical history. Age of onset was operationalized by subtracting patient reported duration of symptoms from patient age at presentation. Pain catastrophizing (PCS) and depression were assessed with the pain catastrophizing scale and hospital anxiety and depression scale (HADS), respectively. Multiple linear regression modeling, with Lasso variable selection, was implemented. Results Pain catastrophizing, anxiety, and depression were not significantly related to age of DDH onset ( p -values > 0.27) or age of FAIS onset ( p -values > 0.29). LASSO-penalized linear regression revealed alpha Dunn angle, Tonnis grade, prior hip surgery, WOMAC pain score, and iHOT total score were associated with age of onset in FAIS (Adjusted R 2 = 0.3099). Lateral center edge angle (LCEA), alpha frog angle, Tonnis grade, SF12 physical functioning, and body mass index (BMI) were associated with age of DDH onset (Adjusted R 2 = 0.3578). Conclusions Psychological factors, as measured by PCS and HADS, were not associated with age of onset in DDH or FAIS. Functional impairment as measured by WOMAC pain and impaired active lifestyle as measured by iHOT were found to affect age of FAIS onset. For DDH, impaired physical functioning and increasing BMI were found to be associated with age of onset. Severity of the disease, as measured radiographically by LCEA and alpha Dunn angle, was also found to be associated with earlier age of onset in DDH and FAIS, respectively. A patient’s radiographic severity may have more of a relationship to the onset of pain than physiologic factors.

What are the significant factors affecting pain in patients with Hartofilakidis type Ι developmental dysplasia of the hip?

“…Radiographic parameters included the acetabular top tilt angle (Tonnis angle), lateral centre-edge angle (LCEA), sharp angle, femoral head extrusion index (EI), sphericity index of the femoral head [ 7 ], Shenton line, osteoarthritis Tonnis grade [ 8 ], joint congruency [ 9 ], P/A ratio and corresponding acetabular anteversion angle (AAA) [ 10 ], and the distance between the medial femoral head and the ilioischial line [ 11 ]. The patients’ age at onset of pain [ 5 , 12 ] and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores were collected. The age at which any item of persistent pain described in the WOMAC pain score scale occurs for the first time is the age at onset of pain [ 5 , 9 , 12 ].…”

“…The patients’ age at onset of pain [ 5 , 12 ] and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores were collected. The age at which any item of persistent pain described in the WOMAC pain score scale occurs for the first time is the age at onset of pain [ 5 , 9 , 12 ]. A WOMAC pain score ≥ 10 was taken as the criterion of severe pain attack [ 9 ].…”

“…Developmental dysplasia of the hip (DDH) is characterised by insufficient coverage of the femoral head and the upper lateral inclination of the acetabular articular surface, resulting in a reduction in the contact area between the femoral head and the acetabulum, joint instability, and acetabular edge overloading, resulting in acetabular labrum and cartilage injury, eventually progressing to secondary osteoarthritis [ 1 – 3 ]. Many patients with DDH with symptoms and limited functions show definite pain symptoms before they develop advanced secondary osteoarthritis [ 4 ], but the reason for the difference in age and degree of painful attacks is not clear [ 5 , 6 ]. Despite the growing development of treatment for patients with DDH, the optimal selection criteria for surgery and factors for symptomatic pain are still evolving.…”

What Are the Significant Factors Affecting Pain in Patients With Hartofilakidis Type I Developmental Dysplasia of the Hip?

“…Radiographic parameters included the acetabular top tilt angle (Tonnis angle), lateral centre-edge angle (LCEA), sharp angle, femoral head extrusion index (EI), sphericity index of the femoral head [7], Shenton line, osteoarthritis Tonnis grade [8], joint congruency [9], P/A ratio and corresponding acetabular anteversion angle (AAA) [10], and the distance between the medial femoral head and the ilioischial line [11]. The patients' pain onset age [5,12] and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores were collected. A WOMAC pain score ≥ 10 was taken as the criterion of severe pain attack [9].…”

“…Developmental dysplasia of the hip (DDH) is characterised by insu cient coverage of the femoral head and the upper lateral inclination of the acetabular articular surface, resulting in a reduction of the contact area between the femoral head and the acetabulum, joint instability, and acetabular edge overloading, resulting in acetabular labrum and cartilage injury, eventually progressing to secondary osteoarthritis [1][2][3]. Many patients with DDH with symptoms and limited functions show de nite pain symptoms before they develop advanced secondary osteoarthritis [4], but the reason for the difference in age and degree of painful attacks is not clear [5,6]. Despite the growing development of treatment for patients with DDH, the optimal selection criteria for surgery and factors for symptomatic pain are still evolving.…”