Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 2—research priorities on conditions affecting the young person’s hip

Abstract

IntroductionPrimary cam morphology is highly prevalent in many athlete populations, causing debilitating hip osteoarthritis in some. Existing research is mired in confusion partly because stakeholders have not agreed on key primary cam morphology elements or a prioritised research agenda. We aimed to inform a more rigorous, inclusive and evidence-based approach to research on primary cam morphology and its natural history by working towards agreement on a set of research priorities for conditions affecting the young person’s hip.MethodsAn international expert panel—the Young Athlete’s Hip Research (YAHiR) Collaborative—rated research priority statements through an online two-round Delphi exercise and met online to explore areas of tension and dissent. Panellists ranked the prioritised research statements according to the Essential National Health Research (ENHR) ranking strategy. Reporting of results followed REPRISE (REporting guideline for PRIority SEtting of health).ResultsA diverse Delphi panel (n=65, Delphi rounds 1 and 2; three ENHR strategy surveys: n=49; n=44; n=42) from 18 countries representing six stakeholder groups, prioritised and ranked 18 of 38 research priority statements. The prioritised statements outlined seven research domains: (1) best practice physiotherapy, (2) rehabilitation progression and return to sport, (3) exercise intervention and load management, (4) primary cam morphology prognosis and aetiology, (5) femoroacetabular impingement syndrome prognosis and aetiology, (6) diagnostic criteria, and (7) screening. The panel recommended areas of tension and dissent for the research community to focus on immediately.ConclusionWhile informing more rigorous, inclusive and evidence-based research, this consensus is a roadmap for researchers, policy-makers and funders to implement research dedicated to reducing the cost and burden of hip disease related to primary cam morphology.

Preventing hip osteoarthritis in athletes: is it really a mission impossible?

“…Such a prevention programme may coincide with a time of skill development and talent identification in some sports, which can jeopardise a young athlete’s ability to reach the elite level. Until we know if primary cam morphology can or should be prevented, we cannot recommend a reduction of exercise loads during adolescence 9. The challenges associated with primary prevention make secondary prevention more attractive.…”

“…The increasing burden of hip OA in athletes and its complex natural history, including, the development and prognosis of primary cam morphology makes prevention challenging. Clinicians and researchers—with athlete and patient partners—have prioritised research to grapple with these complexities 9. To prevent hip OA in all athletes, we should: (1) work to better understand how primary cam morphology and other relevant hip morphologies develop and their causal role in early hip OA; (2) develop and evaluate secondary prevention strategies to slow/prevent hip OA development; and (3) perform qualitative research of athletes with hip OA to understand the lived experience.…”

Infographic. Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome—natural history of primary cam morphology to inform clinical practice and research priorities on conditions affecting the young person’s hip

“…H Paul Dijkstra , 1,2 Sean Mc Auliffe , 3,4 Clare L Ardern , 5,6 Joanne L Kemp , 6 Andrea Britt Mosler , 6 Amy Price , 7 Paul Blazey , 8 Dawn Richards, 9…”

“…This infographic illustrates the natural history of primary cam morphology (PCM) to inform the Oxford Consensus Study’s seven prioritised research domains on conditions affecting the young person’s hip 1 2. We share 16 key messages for athletes, patients, clinicians and researchers:…”

First-line treatment for femoroacetabular impingement syndrome and hip-related quality of life: study protocol for a multicentre randomised controlled trial comparing a 6-month supervised strength exercise intervention to usual care (the Better Hip Trial)

“…[12][13][14][15] There is a consensus that first-line treatment in most patients should be non-surgical. 16 Since a proportion of patients seem to respond positively to physiotherapy, including pain medication, patient education, activity modification and strengthening exercises, a physiotherapy intervention is recommended before considering surgery. 2 14 17 Several RCTs have investigated the effectiveness of non-surgical treatment compared with surgical treatment.…”