Skip to main content
Download PDF

Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip

BMC Musculoskeletal Disorders volume 24, Article number: 635 (2023) Cite this article

Abstract

Background

Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function.

Methods

This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman’s rank correlation coefficients. Statistical correlation strength was defined as low (r =  ± 0.1–0.3), moderate (r =  ± 0.3–0.5) and strong (r >  ± 0.5).

Results

Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain.

Conclusion

Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions.

Peer Review reports

Background

Femoroacetabular impingement syndrome (FAIS) and developmental dysplasia of the hip (DDH) are common causes of hip pain and impaired function in young adults that may lead to premature development of hip osteoarthritis [1,2,3,4]. FAIS is characterized by recurrent abutment of the femoral head-neck junction and acetabular rim during near-terminal joint articulation [5]. Morphologic causes of the dynamic pathomechanics of FAIS are excessive acetabular coverage (i.e., pincer morphology) and/or asphericity of the femoral head (i.e., cam morphology) [6]. DDH is characterized by a shallow acetabulum and lateralized hip joint center [7]. Although the pathomechanics of FAIS and DDH are different, both can limit the quality of life and cause hip pain.

Impaired physical function is associated with both FAIS and DDH [5, 8]; however, the specific mechanism by which aberrant hip morphology translates to impaired function is different between the two pathologies. For FAIS, recent findings suggest that altered biomechanics observed during level walking may be a protective mechanism [9]. In addition, although the hip range-of-motion (ROM) demands of level walking are unlikely to induce impingement, these patients tend to avoid excessive hip articulation as a response to previously experienced hip pain [10]. Thus, for patients with FAIS, reduced performance during less demanding tasks may be more attributable to psychological impediments rather than biomechanically impaired function. Patients with FAIS also demonstrate altered kinematics and kinetics during tasks with high hip ROM demands, such as squatting and stair climbing [11, 12]. By contrast in DDH, a shallow acetabulum and lateralized hip joint center result in lower torque generating capacity of the hip abductors and higher joint reaction forces. As a result, the hip joint may be destabilized [13, 14]. This localized mechanical effect manifests in broad biomechanical alterations, such as increased kinematic variability during ambulation and lower peak hip flexion during single-leg squatting compared to healthy individuals [15, 16].

Quantifying functional decrements in hip patients is important for treatment planning. Patient outcomes can be grouped into objectively measured function (OBJ-F), patient-reported outcome measures of function (PROM-F), and patient-reported outcome measures of pain (PROM-P). Treating physicians rely on PROM-F and PROM-P to assess symptoms and track post-surgery improvements. Numerous studies have examined the relationship between perceived and true function in patients who have undergone total hip and knee replacement [17,18,19,20,21,22,23,24,25], but less is known for patients with FAIS and DDH. Scott et al [26] demonstrated strong correlation between PROM-F and OBJ-F in patients with DDH, suggesting that such patients have an accurate perception of their own abilities that is not skewed by perceived limitations. As a secondary aim, the authors determined that patient-reported pain was not well correlated with measures of function in patients with DDH. By contrast, the psychological pain-avoidance mechanisms theorized for patients with FAIS may limit the agreement between perceived and true function [9]. That is, patients with FAIS may inaccurately estimate their level of functional impairment. The lack of knowledge of potential discrepancies between patient measurement modalities has been noted previously [27,28,29]. Improving our understanding of these relationships will provide insight into the pathophysiology of FAIS and DDH while informing the optimal use of patient data instruments.

The purpose of this study was (1) to evaluate differences of function and pain in patients with FAIS and DDH, (2) to assess the correlation between perceived and true functional ability, and (3) to determine the influence of pain on measures of function. We hypothesized that patients with DDH would report higher pain and perform worse on functional tasks that demand hip power and stability compared to patients with FAIS, that patients with FAIS would exhibit weaker correlation between OBJ-F and PROM-F compared to patients with DDH, and that, in both patient groups, PROM-P would be weakly correlated with OBJ-F compared to PROM-F.

Materials and methods

Patients and study design

This prospective cross-sectional study of patients with FAIS and patients with DDH was approved by the University of Texas Southwestern Institutional Review Board and completed during a 33-month time period. Patients scheduled for future hip preservation surgery at our institution were eligible for inclusion. All included patients were diagnosed by a fellowship-trained hip preservation orthopedic surgeon [30, 31]. Patients with symptomatic DDH, radiographic evidence of femoral head uncovering, and a lateral center–edge angle (LCEA) of < 25º were offered treatment with periacetabular osteotomy. Patients with symptomatic FAIS, radiographic evidence of FAIS CAM or Pincer, an alpha angle of > 65º, an LCEA of > 38º, head and neck offset deformity, and positive impingement sign were offered treatment with hip arthroscopy or surgical hip dislocation. Details of our radiographic procedure have been described previously by Wells et al [30]. The LCEA, Tönnis angle, joint space width, Tönnis grade, and congruency were measured on standing anteroposterior radiographs. The ACEA was measured on false-profile radiographs. Alpha angle was measured on Dunn and frog-leg radiographs. Exclusion criteria were onset of osteoarthritis or a history of previous osteotomy or arthroplasty in either hip. Written consent was obtained from all patients included in this study.

Instrumentation

Questionnaire data, which have previously been validated [32,33,34,35,36,37], were collected during a pre-surgical clinic visit. Objective measures of function were also collected pre-operatively under the supervision of a single licensed physical therapist with 8 years of experience. Variables were grouped into OBJ-F, PROM-F, and PROM-P. OBJ-F instrumentation consisted of the 6-min walk test (6MWT), single leg hop test (SLHT), Biodex sway test (BST), hip abduction strength test (HABST), and STAR excursion balance reach tests (STAR) in multiple directions. The HABST was performed while side-lying with the testing limb in end-range extension and 10–20 degrees of abduction. The dynamometer was held proximal to the lateral malleolus while instruction was provided to abduct as hard as possible. For tests performed unilaterally, only scores for the limb indicated for surgery were included. PROM-F consisted of UCLA Activity scale, Hip Outcome Score (HOS) activities of daily living (ADL) and Sport subscales, Short Form 12 (SF-12) Physical Activity subscale, and the Hip Disability and Osteoarthritis Outcome Score (HOOS) ADL and Sport subscales. For PROM-P, the following were included: HOOS Pain subscale, visual analogue scale (VAS), and an anatomical pain location scale with the following body locations: groin, anterior thigh, knee, low back, buttock, posterior thigh, trochanter, and lateral thigh. The anatomical pain location scale was previously described by Nam et al [38]. The scores for frequency and intensity of pain were multiplied together as an aggregate measure of pain at each body location.

Statistical methods

Statistical analyses were carried out using a custom Python script which included with the Scikit-learn and NumPy packages. Patient demographics were compared using independent two-sample t-tests, except for biological sex which was compared using a chi-square test. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Additionally, the rank-biserial correlation, a measure of effect size commonly reported alongside the Wilcoxon Rank-Sum test, was computed. Within-group relationships between pairs of outcome variables were analyzed using Spearman’s rank correlation coefficients. The level of significance for between-group comparisons was set at α = 0.05. To address the problem of multiple comparisons that occurs during correlation of a large number of outcomes, the Benjamini–Hochberg procedure was performed with the false discovery rate set at Q = 0.05. Strength of correlations was defined as low (r =  ± 0.1–0.3), moderate (r =  ± 0.3–0.5) and strong (r >  ± 0.5) [39]. For the correlation analysis, the HOOS Pain and BST scales were inverted so that higher scores always indicate higher pain and function.

Results

Patient demographics

Forty-two patients with FAIS and 39 patients with DDH were approached for participation in the current study. Of the 42 patients with FAIS, seven were excluded due to previous osteotomy. Of the 42 patients with DDH, three were excluded due to previous osteotomy, one was excluded due to previous contralateral total hip replacement, and one was excluded due to onset of osteoarthritis. Our included sample of 35 patients with FAIS and 37 patients with DDH were 60% and 92% female, respectively (p = 0.001). The mean age was 33.46 years for patients with FAIS (SD: 11.89; range: 16–56) and 25.54 years for patients with DDH (SD: 6.24; range: 17–37). The patients with FAIS were significantly older than the patients with DDH (p < 0.001; CI: 3.49 to 12.35). Mean body mass index was not significantly different (p = 0.907; CI: -2.08 to 2.73) between the patients with FAIS (mean: 26.19 kg/m2, SD: 4.93) and patients with DDH (mean: 25.87 kg/m2, SD: 5.27). Radiographic characteristics of these patients are presented in Table 1.

Table 1 Radiographic measurements of patients
Full size table

Direct comparison of outcomes between patient groups

No differences in objectively measured function were detected between patients with FAIS and DDH (Table 2). Patients with DDH indicated significantly lower activity and physical function in ADL and Sport domains compared to patients with FAIS as indicated by UCLA Activity (p = 0.025), HOS ADL (p = 0.013), SF-12 Physical Function (p = 0.021), and HOOS Sport (p = 0.030) scores (Table 3). Patients with DDH also reported significantly higher levels of pain compared to patients with FAI as indicated by HOOS Pain (p = 0.012) score (Table 4).

Table 2 Objectively measured function scores
Full size table
Table 3 Patient-Reported function scores
Full size table
Table 4 Patient-reported pain scores
Full size table

Relationship between perceived and objectively measured functional ability

For both patient groups (FAIS: Fig. 1; DDH: Fig. 2), 6MWT distance was significantly correlated with PROM-F except for % Normal Function and HOOS Sport scores (r = 0.36 to 0.62).

Fig. 1
figure 1

Correlations between functional outcomes (horizontal axis) and patient-reported function (vertical axis) for the FAI syndrome patient group

Full size image
Fig. 2
figure 2

Correlations between functional outcomes (horizontal axis) and patient-reported function (vertical axis) for the DDH patient group

Full size image

In patients with DDH, SLHT distance was significantly correlated with all PROM-F measures except for HOOS Sport. BST scores were not correlated with PROM-F in patients with FAIS, but BST Eyes Open was well correlated with HOS ADL (r = 0.55) and Sport (r = 0.47) scores in patients with DDH. HABST score was not correlated with PROM-F in either patient group. Mean of all correlation coefficients was smaller for patients with FAIS (mean: 0.19, SD: 0.14) compared to patients with DDH (mean: 0.28, SD: 0.15), suggesting a weaker overall relationship between OBJ-F and PROM-F in patients with FAIS.

Relationship between objectively measured functional ability and pain

In patients with FAIS (Fig. 3), the only significant correlation between PROM-P and OBJ-F was between 6MWT distance and HOOS Pain score (r = -0.53). In patients with DDH (Fig. 4), 6MWT distance was significantly correlated with VAS Average pain (r = -0.53) and VAS Best pain (r = -0.52). Overall, correlation coefficients for OBJ-F and PROM-P were low for both patients with FAIS (mean: 0.13, SD: 0.10) and DDH (mean: -0.05, SD: 0.19), indicating a weak relationship overall between OBJ-F and PROM-P in the two patient groups.

Fig. 3
figure 3

Correlations between patient-reported pain (horizontal axis) and functional outcomes (vertical axis) for the FAI syndrome patient group

Full size image
Fig. 4
figure 4

Correlations between patient-reported pain (horizontal axis) and functional outcomes (vertical axis) for the DDH patient group

Full size image

Relationship between perceived functional ability and pain

Significant correlations between PROM-P and PROM-F were fewer in patients with FAIS (Fig. 5) compared to patients with DDH (Fig. 6). In patients with FAIS, a number of PROM-F measures were strongly significantly correlated with HOOS Pain (r = -0.58 to -0.93) and VAS Worst pain (r = -0.54 to -0.68).In patients with DDH, a number of PROM-F measures were significantly correlated with HOOS Pain (r = -0.45 to -0.82), and VAS Average (r = -0.47 to -0.72), Best (r = -0.45 to -0.62), and Worst (r = -0.53 to -0.65). PROM-P was overall better correlated to PROM-F than OBJ-F in both FAIS (mean: -0.24, SD: 0.21) and DDH (mean: -0.24, SD: 0.24) patients.

Fig. 5
figure 5

Correlations between patient-reported pain (horizontal axis) and patient-reported function (vertical axis) for the FAI syndrome patient group

Full size image
Fig. 6
figure 6

Correlations between patient-reported pain (horizontal axis) and patient-reported function (vertical axis) for the DDH patient group

Full size image

Discussion

The purpose of this study was to evaluate differences of function and pain in patients with FAIS and patients with DDH, to assess the correlation between perceived and true functional ability, and to determine the influence of pain on measures of function. Delineating the symptoms of FAIS and DDH using common clinical measures could help facilitate accurate diagnosis of hip disease [40, 41] and shed new light on how self-perception of pain and function, and their relationships with objectively measured function may depend on underlying pathology.

Our first hypothesis, that patients with DDH would report higher pain and perform worse on functional tasks that demand hip power and stability compared to patients with FAIS, was partially supported. Pain levels were lower in patients with FAIS as indicated by HOOS Pain scores, but functional tasks with specific demands for hip power, balance, and stability—namely SLHT, BST, and STAR—were not significantly different between patient groups. Walking ability and hip abduction strength were significantly lesser in patients with DDH compared to patients with FAIS. Consistent with our findings, hip abduction strength decrements are well documented in patients with DDH [13, 14, 42]. Between-group differences in scores for UCLA Activity, HOS ADL, SF-12 Physical Function, and HOOS Sport suggest that patients with FAIS are able to participate in higher intensity physical activity with less interference from hip pain compared to patients with DDH. While attempting to distinguish FAIS and DDH through clinical measures, Kappe et al [40] found no significant differences in Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Function subscales between patient groups. WOMAC is comparable to HOS and HOOS.

Interestingly in our study, although HOS ADL and HOOS Sport subscales were significantly different between patient groups, HOS Sport and HOOS ADL subscales were not. The inclusion of relatively nondemanding tasks in HOS Sport and HOOS ADL may have contributed to their lack of differences. When evaluating patients with FAIS and patients with DDH separately, some studies have reported different PROM scores compared to our study. Wasko et al [43] reported higher mean HOOS ADL scores (mean: 66.6, SD: 21.6), higher HOOS Sport (mean: 40.9, SD: 25.3), and lower HOOS Pain (mean: 54.4, SD: 20.7) scores for a cohort of 302 pre-operative patients with DDH (sex: 84% female, median age: 21 [17 to 29] yrs, median BMI: 23.4 [20.8 to 26.3] kg/m2). Nepple et al [44] reported lower mean HOOS ADL (mean: 65.6, SD: 21.3), similar mean HOOS Sport (mean: 45.2, SD: 24.6), and lower HOOS Pain (mean: 56.1, SD: 20.7) for a cohort of 621 pre-operative patients with FAIS (sex: 50% female, mean age: 24.9 ± 9.1). These differences in reported symptoms illustrate the high variability and overlap of symptoms in FAIS and DDH. Simple comparisons of individual scores do not provide insight into how expressions of pain and function are dictated by the underlying hip pathology. Thus, we performed a detailed correlation analysis.

Our second hypothesis was that patients with FAIS would exhibit less widespread correlation between OBJ-F and PROM-F measures compared to patients with DDH. This hypothesis was supported, given the limited number of significant correlations for FAIS compared to DDH. In patients with FAIS, PROM-F instruments were well correlated only with walking ability. Lack of agreement between perceived and true function may point to the previously referenced protective mechanisms at play by these patients. In patients with DDH, PROM-F instruments were well correlated with walking ability as well as single leg hopping and postural stability, tasks known to be challenging for patients with DDH. Consistent with our findings, Scott et al [26] found strong correlations between common PROMs and functional tasks that have high demands for walking ability, lower limb strength, and dynamic balance in patients with DDH. Since 6MWT was well correlated with PROM-F in both patient groups and requires minimal time and equipment, the test could be performed in place of PROM-F instruments. Previous studies have examined correlations between the responsiveness of OBJ-F and PROM-F in post-operative total hip and knee replacement patients and found inconsistencies between objectively measured and perceived functional improvements [25, 28, 29]. Since the agreement among the responsiveness of these measurement modalities has not yet been studied in patients with pre-arthritic hip conditions, our findings serve as an important baseline for future study.

The UCLA Activity scale was previously validated by correlation with pedometry in lower limb joint reconstruction patients [45, 46]. However, latter items on the scale exceed the demands of normal walking. Thus, it was previously unclear how the scale relates to tasks that demand greater lower limb strength, power, postural stability, and dynamic balance. In the current study, UCLA Activity score was moderately positively correlated with objective measures of walking ability and dynamic balance in patients with FAIS, and with walking ability and single leg hopping in patients with DDH.

Our third hypothesis was that PROM-P would be well correlated with PROM-F, and only weakly correlated with OBJ-F in both patient groups. This hypothesis was well supported. Correlations between OBJ-F and PROM-P were sparse in both patient groups, as only one significant correlation was observed in patients with FAIS, and two were observed in patients with DDH. Unlike patients with other hip and knee pathologies, functional performance of patients with DDH is strongly influenced by pain [17, 19, 21,22,23,24, 28]. Overall PROM-P measures had better agreement with PROM-F than with OBJ-F measures. This suggests that pain has a stronger influence on perceived function than true function [18, 20].

Some limitations were present in our study. Because all included patients were scheduled for preservative surgery, they represent the most symptomatic patients of their respective pathology. Thus, application of our findings should be limited to patients who are moderately-to-severely symptomatic. Secondly, our findings may have been influenced by the differing age and sex distribution between FAIS and DDH. Nevertheless, our patient sample were a consecutive series of pre-operative patients from our hip preservation practice, and their age and sex distributions reflect those of typical demographics for these pathologies [47, 48].

Future work should investigate the relationship between post-operative improvements in PROMs and OBJ-F in patients with FAIS and patients with DDH. Additionally, a study that includes non-operative patients with FAIS and DDH may provide a broader view of how hip morphology influences pain and function. Furthermore, as suggested by Hampton et al [49], it may be possible to alter how patients perceive their functional ability and experience of pain to promote further recovery of function post-operatively.

Conclusions

Our study highlights that patients with DDH experience increased pain and decreased function compared to patients with FAIS. Moreover, the relationships between pain and function appear to differ depending on the underlying hip pathology. This was notably reflected in the dissimilar correlations between patient-reported pain measures (i.e., HOOS Pain and VAS) with patient-reported function measures. Understanding these differences is valuable for informing clinical management and treatment decisions. We recommend that these insights should be incorporated in the evaluation and selection of surgical and therapeutic interventions by prospective patients. Finally, our study revealed a close correlation between performance during sustained walking bouts (i.e., 6MWT) and patient-reported pain and function in both patient cohorts. In patients with DDH specifically, we demonstrated an additional correlation between performance during hopping (i.e., SLHT) and patient-reported function. Therefore, we recommend that clinicians could utilize these practical functional measures, especially when the administration of multiple patient-reported outcome measures may be infeasible or burdensome to acquire within the clinical setting.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

6MWT:

6-Minute walk test

ADL:

Activities of daily living

BST:

Biodex sway test

DDH:

Developmental dysplasia of the hip

FAIS:

Femoroacetabular impingement syndrome

HABST:

Hip abduction strength test

HOS:

Hip Outcome Score

HOOS:

Hip Disability and Osteoarthritis Outcome Score

OBJ-F:

Objective measures of function

PROM-F:

Patient-reported measures of function

PROM-P:

Patient-reported measures of pain

ROM:

Range of motion

SF-12:

Short Form 12

SLHT:

Single leg hop test

STAR:

Star excursion balance reach test

VAS:

Visual analogue scale

References

  1. Harris-Hayes M, Royer NK. Relationship of acetabular dysplasia and femoroacetabular impingement to hip osteoarthritis: a focused review. PM R. 2011;3(11):1055–67 (Elsevier Inc).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res Lippincott Williams and Wilkins. 2003;417:112–20.

    Article  Google Scholar 

  3. Lievense AM, Bierma-Zeinstra SMA, Verhagen AP, Verhaar JAN, Koes BW. Influence of hip dysplasia on the development of osteoarthritis of the hip. Ann Rheum Dis. 2004;63(6):621–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Clohisy JC, Beaulé PE, O’Malley A, Safran MR, Schoenecker P. Hip disease in the young adult: Current concepts of etiology and surgical treatment. Journal of Bone and Joint Surgery - Series A Journal of Bone and Joint Surgery Inc., 2008;11:2267–2281.

  5. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. New York: Clin Orthop Relat Res Springer; 2009. p. 638–44.

    Google Scholar 

  6. Lorenzon P, Scalvi A, Scalco E. The painful hip in young adults between impingement and mild dysplasia: clinical and instrumental diagnostical criteria. Acta Biomedica Mattioli. 1885;2020(91):11–20.

    Google Scholar 

  7. Harris MD, MacWilliams BA, Bo Foreman K, Peters CL, Weiss JA, Anderson AE. Higher medially-directed joint reaction forces are a characteristic of dysplastic hips: a comparative study using subject-specific musculoskeletal models. J Biomech Elsevier Ltd. 2017;54:80–7.

    Article  Google Scholar 

  8. Scott EJ, Willey MC, Mercado A, Davison J, Wilken JM. Assessment of disability related to hip dysplasia using objective measures of physical performance. Orthop J Sports Med SAGE Publ Ltd. 2020;8(2):2325967120903290.

    Google Scholar 

  9. Samaan MA, Zhang AL, Popovic T, Pedoia V, Majumdar S, Souza RB. Hip joint muscle forces during gait in patients with femoroacetabular impingement syndrome are associated with patient reported outcomes and cartilage composition. J Biomech Elsevier Ltd. 2019;84:138–46.

    Article  Google Scholar 

  10. Diamond LE, Wrigley TV, Bennell KL, Hinman RS, O’Donnell J, Hodges PW. Hip joint biomechanics during gait in people with and without symptomatic femoroacetabular impingement. Gait Posture Elsevier. 2016;43:198–203.

    Article  Google Scholar 

  11. Ng KG, Mantovani G, Modenese L, Lamontagne M. Altered walking and muscle patterns reduce hip contact forces in individuals with symptomatic cam femoroacetabular impingement. Am J Sports Med. 2018;46(11):2615–23.

    Article  PubMed  Google Scholar 

  12. King MG, Lawrenson PR, Semciw AI, Middleton KJ, Crossley KM. Lower limb biomechanics in femoroacetabular impingement syndrome: a systematic review and meta-analysis. Br J Sports Med. 2018;52:566–80 (BMJ Publishing Group).

    Article  PubMed  Google Scholar 

  13. Song K, Gaffney BMM, Shelburne KB, Pascual-Garrido C, Clohisy JC, Harris MD. Dysplastic hip anatomy alters muscle moment arm lengths, lines of action, and contributions to joint reaction forces during gait. J Biomech. 2020;110:109968 (Elsevier Ltd).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Harris MD, Shepherd MC, Song K, Gaffney BMM, Hillen TJ, Harris-Hayes M, et al. The biomechanical disadvantage of dysplastic hips. J Orthop Res. 2021;40(6):1387–96 (John Wiley and Sons Inc).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Loverro KL, Khuu A, Kao PC, Lewis CL. Kinematic variability and local dynamic stability of gait in individuals with hip pain and a history of developmental dysplasia. Gait Posture. 2019;68:545–54 (Elsevier B.V).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Harris-Hayes M, Hillen TJ, Commean PK, Harris MD, Mueller MJ, Clohisy JC, et al. Hip kinematics during single leg tasks in people with and without hip-related groin pain and the association among kinematics, hip muscle strength and bony morphology. J Orthop Sports Phys Ther. 2020;50(5):243–51.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stratford PW, Kennedy DM. Performance measures were necessary to obtain a complete picture of osteoarthritic patients. J Clin Epidemiol. 2006;59(2):160–7.

    Article  PubMed  Google Scholar 

  18. Stratford PW, Kennedy DM, Woodhouse LJ. Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee. Phys Ther. 2006;86(11):1489–96.

    Article  PubMed  Google Scholar 

  19. Kennedy D, Stratford PW, Pagura SMC, Walsh M, Woodhouse LJ. Comparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates. J Arthroplasty. 2002;17(1):70–7 (Churchill Livingstone Inc).

    Article  PubMed  Google Scholar 

  20. Terwee CB, van der Slikke RMA, van Lummel RC, Benink RJ, Meijers WGH, de Vet HCW. Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients. J Clin Epidemiol. 2006;59(7):724–31.

    Article  PubMed  Google Scholar 

  21. Gandhi R, Tsvetkov D, Davey JR, Syed KA, Mahomed NN. Relationship between self-reported and performance-based tests in a hip and knee joint replacement population. Clin Rheumatol. 2009;28(3):253–7.

    Article  PubMed  Google Scholar 

  22. Witvrouw E, Victor J, Bellemans J, Rock B, van Lummel R, van der Slikke R, et al. A correlation study of objective functionality and WOMAC in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2002;10(6):347–51.

    Article  CAS  PubMed  Google Scholar 

  23. Mizner RL, Petterson SC, Clements KE, Zeni JA, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments. A longitudinal analysis of outcomes. J Arthroplasty. 2011;26(5):728–37.

    Article  PubMed  Google Scholar 

  24. Jacobs CA, Christensen CP. Correlations between knee society function scores and functional force measures. Clin Orthop Relat Res Springer New York. 2009;467(9):2414–9.

    Article  Google Scholar 

  25. Luna IE, Kehlet H, Peterson B, Wede HR, Hoevsgaard SJ, Aasvang EK, et al. Early patient-reported outcomes versus objective function after total hip and knee arthroplasty. Bone Joint J. 2017;9:99–1167.

    Google Scholar 

  26. Scott EJ, Willey MC, Mercado A, Davison J, Wilken JM. Assessment of Disability Related to Hip Dysplasia Using Objective Measures of Physical Performance. Orthop J Sports Med SAGE Publications Ltd, 2020;8(2). https://doi.org/10.1177/2325967120903290.

  27. Konan S, Hossain F, Patel S, Haddad FS. Measuring function after hip and knee surgery: the evidence to support performance-based functional outcome tasks. Bone Joint J. 2014;96(11):1431–5.

    Article  PubMed  Google Scholar 

  28. Stevens-Lapsley JE, Schenkman ML, Dayton MR. Comparison of self-reported knee injury and osteoarthritis outcome score to performance measures in patients after total knee arthroplasty. PM and R. 2011;3(6):541–9.

    Article  PubMed  Google Scholar 

  29. Dayton MR, Judd DL, Hogan CA, Stevens-Lapsley JE. Performance-based versus self-reported outcomes using the hip disability and osteoarthritis outcome score after total hip arthroplasty. Am J Phys Med Rehabil Lippincott Williams Wilkins. 2016;95(2):132–8.

    Article  Google Scholar 

  30. Wells J, Schoenecker P, Duncan S, Goss CW, Thomason K, Clohisy JC. Intermediate-term hip survivorship and patient-reported outcomes of periacetabular osteotomy. J Bone Joint Surg. 2018;100(3):218–25 (American Volume Lippincott Williams and Wilkins).

    Article  PubMed  Google Scholar 

  31. Wells J, Millis M, Kim YJ, Bulat E, Miller P, Matheney T. Survivorship of the bernese periacetabular osteotomy: what factors are associated with long-term failure? Clin Orthop Relat Res Springer New York LLC. 2017;475(2):396–405.

    Article  Google Scholar 

  32. Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M, et al. The warwick agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports. 2016;50(19):1169–76 (BMJ Publishing Group).

    Article  CAS  Google Scholar 

  33. Ware JE, Kosinski M, Keller S. Estimation of medical care total expenditures View project A 12-Item Short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.

    Article  PubMed  Google Scholar 

  34. Jensen MP, Mcfarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 1993;55:195–203.

    Article  PubMed  Google Scholar 

  35. Impellizzeri FM, Jones DM, Griffn D, Harris-Hayes M, Thorborg K, Crossley KM, et al. Patient-reported outcome measures for hip-related pain: A review of the available evidence and a consensus statement from the International Hiprelated Pain Research Network, Zurich 2018. Br J Sports Med. 2020;54(14):848–57 (BMJ Publishing Group).

    Article  PubMed  Google Scholar 

  36. Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res (Hoboken) 2011;63(SUPPL. 11):S200-7.

  37. Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res Springer New York. 2009;467(4):958–65.

    Article  Google Scholar 

  38. Nam D, Meyer Z, Rames RD, Nunley RM, Barrack RL, Roger DJ. Is the direct superior, iliotibial band-sparing approach associated with decreased pain after total hip arthroplasty? J Arthroplasty. 2017;32(2):453–7 (Churchill Livingstone Inc).

    Article  PubMed  Google Scholar 

  39. Cohen J. A Power Primer. Psychol Bull New York City. 1992;112(1):155–9.

    CAS  Google Scholar 

  40. Kappe T, Kocak T, Reichel H, Fraitzl CR. Can femoroacetabular impingement and hip dysplasia be distinguished by clinical presentation and patient history? Knee Surg Sports Traumatol Arthrosc. 2012;20(2):387–92.

    Article  PubMed  Google Scholar 

  41. Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P, et al. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med: BMJ Publishing Group; 2020.

    Book  Google Scholar 

  42. Sørensen H, Nielsen DB, Jacobsen JS, Søballe K, Mechlenburg I. Isokinetic dynamometry and gait analysis reveal different hip joint status in patients with hip dysplasia. HIP International SAGE Publications Ltd. 2019;29(2):215–21.

    Google Scholar 

  43. Wasko MK, Yanik EL, Pascual-Garrido C, Clohisy JC. Psychometric Properties of Patient-Reported Outcome Measures for Periacetabular Osteotomy. Journal of Bone and Joint Surgery - American Volume Lippincott Williams and Wilkins, 2019;101(6):e21.

  44. Nepple JJ, Zaltz I, Larson CM, Beaulé PE, Kim YJ, Millis MB, et al. Surgical treatment of femoroacetabular impingement: hip arthroscopy versus surgical hip dislocation: a propensity-matched analysis. J Bone Joint Surg Am NLM (Medline). 2020;102:51–8.

    Article  Google Scholar 

  45. Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13(8):890–5.

    Article  CAS  PubMed  Google Scholar 

  46. Morcos MW, Teeter MG, Somerville LE, Lanting B. Correlation between hip osteoarthritis and the level of physical activity as measured by wearable technology and patient-reported questionnaires. J Orthop Reed. 2020;20:236–9 (Elsevier India Pvt. Ltd).

    Google Scholar 

  47. Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN Orthop Hindawi Limited. 2011;2011:1–46.

    Google Scholar 

  48. Hale RF, Melugin HP, Zhou J, LaPrade MD, Bernard C, Leland D, et al. Incidence of femoroacetabular impingement and surgical management trends over time. American J Sports Med. 2021;49(1):35–41 (SAGE Publications Inc).

    Article  Google Scholar 

  49. Hampton S, Nakonezny P, Richard H, Wells J. Pain catastrophizing, anxiety, and depression in hip pathology. Bone Joint J. 2019;101:800–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Collection of data for this study was made possible by funding from The Once Upon a Time Foundation. The foundation had no role in conducting this study or preparing the manuscript.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA

    Brandon Nunley

  2. School of Medicine, Tufts University, Boston, MA, USA

    Edward P. Mulligan

  3. Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA

    Avneesh Chhabra

  4. Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA

    Nicholas P. Fey

  5. Department of Orthopedic Surgery, Baylor Scott & White Medical Center, 301 N. Washington Ave, Dallas, TX, 75246, USA

    Joel Wells

Authors
  1. Brandon Nunley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward P. Mulligan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Avneesh Chhabra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicholas P. Fey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joel Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

B.N. contributed to the design of the study, analysis, interpretation, writing, and preparation of all figures. E.P.M. contributed to conception, interpretation of data, and substantial revisions. A.C. contributed to conception, design of the study, interpretation of data, and substantial revisions. N.P.F. contributed to conception, design of the study, data analysis, interpretation of data, and substantial revisions. J.W. contributed to conception, interpretation of the data, and substantial revisions. All authors reviewed and approved the final manuscript for publication.

Corresponding author

Correspondence to Joel Wells.

Ethics declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki and approved by the University of Texas Southwestern Institutional Review Board. Written informed consent was obtained from all included patients.

Consent for publication

Not Applicable.

Competing interests

AC receives royalties from Jaypee and Wolters. AC also serves as a consultant with ICON Medical and Treace Medical Concepts, Inc. AC is a speaker for Siemens. AC is medical advisor and has research grant from Image biopsy lab Inc. All other authors have no competing interests to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nunley, B., Mulligan, E.P., Chhabra, A. et al. Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip. BMC Musculoskelet Disord 24, 635 (2023). https://doi.org/10.1186/s12891-023-06768-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12891-023-06768-1

Keywords

BMC Musculoskeletal Disorders

ISSN: 1471-2474

Contact us