Paper #35 - ISHA Annual Scientific Meeting 2016

Hypermobility: a Key Factor in Hip Dysplasia. A Prospective Evaluation of 266 Patients.

Gregory Gosey, San Diego, CA UNITED STATES
Michael Muldoon, MD, San Diego, CA UNITED STATES
Robert Healey , MS, San Diego, CA UNITED STATES
Richard Santore, MD, San Diego, CA UNITED STATES

San Diego Hip Preservation Center, SD, CA, UNITED STATES

FDA Status Not Applicable

Summary: In this prospective observational study of 266 adults with hip and knee disorders including 36 with dysplasia, we show an 83.3% prevalence of hypermobility in dysplasia. The prevalence and severity of hypermobility in dysplasia were statistically significantly greater by multiple metrics than in other hip and knee diagnoses.

Abstract:
Introduction:
Hypermobility is a condition associated with dysfunction of multiple joints. However the epidemiology in adults with hip and knee pain is unknown. The purpose of this study was to evaluate the prevalence of hypermobility in our adult patients.

Methods:
All new patients presenting for initial evaluation of a hip or knee complaint were prospectively evaluated for Generalized Joint Hypermobility (GJH) by the 9-point Beighton physical exam criteria and Hakim & Grahame’s 5-item questionnaire. Beighton score of =4 and/or questionnaire response of =2 was required for diagnosis of GJH. Patients with prior joint reconstruction or inability to perform exam maneuvers were excluded. Main-effects linear and multiple logistic regressions, respectively, were used to plot Beighton scores and presence of hypermobility by Beighton criteria and Hakim-Grahame criteria against diagnosis, age, sex, and race.

Results:
In 266 patients (mean age 48.0 yrs; 58.3% female) with dysplasia, hip and knee osteoarthritis, femoroacetabular impingement, and other hip and knee diagnoses, hypermobility was found by Beighton scores and/or questionnaire responses in 43.2% (Table 1). The greatest Beighton scores (mean 4.06) and prevalence of hypermobility, by both Beighton and Hakim-Grahame criteria, were found in dysplasia (66.7% and 83.3%, respectively). By these respective criteria, hypermobility was 6.58 (p<0.001) and 4.55 (p<0.001) times as likely as in other hip disorders. Hypermobility status did not differ among other diagnoses. Female sex and younger age significantly predicted all hypermobility metrics (p=0.003). Race did not significantly predict hypermobility.

Conclusion:
A substantial proportion of patients with hip pain demonstrated hypermobility, most prevalent in dysplasia with high statistical significance. Further study is warranted to clarify the clinical significance of these findings. However, we believe the presence of hypermobility may necessitate lowering the threshold for periacetabular osteotomy in patients with mild dysplasia and may warrant capsular closure during hip arthroscopy.