EP9.8 Postpartum Hip Problems: Presentation, Pathology, and Diagnosis

Abstract

Abstract Background Hip pain in the postpartum patient can be a difficult problem to diagnose and subsequently treat due to the variety of potential conditions at fault. While orthopaedic conditions including pregnancy-related lumbar disc herniation, cauda equina syndrome, pubic symphysis rupture, and pelvic girdle pain have been previously described in the literature, there is a paucity of data regarding partum hip injuries as a source of hip pain in the postpartum patient. Purpose The purpose of this study was to examine the presentation, pathology, and treatment of patients who underwent hip arthroscopy for hip pain resulting from pregnancy or delivery, and to provide a framework for first-line prevention and management of these patients. Methods Data was prospectively collected and retrospectively analyzed for patients who underwent primary hip arthroscopy for hip pain following pregnancy and delivery from 2013 through 2024. Patients were included if they indicated significant hip pain as a direct result of pre-operative pregnancy status and delivery, as indicated in the office note. Results 25 hips that underwent primary hip arthroscopy for hip pain following pregnancy or delivery were included in the study. Of the patients included, 12 reported pain beginning during pregnancy and 13 reported pain beginning at the time of delivery. Patients sought care for hip pain an average of 1.85 ± 19.4 months following delivery. Notably, postpartum, pre-operative physical examination showed a relatively high average Beighton’s score of 3.5 ± 2.7, and a high flexion average measurement of 118.0 ± 10.1, indicating a prevalence of inherent instability and ligamentous laxity. It was also found on physical exam that forty-four percent of patients experienced pain in flexion and 40% experienced pain in internal rotation. Radiographically, 22 (88%) of the patient cohort presented with cam morphology and 15 (60%) with pincer morphology. Intraoperatively, 48% of patients had a combined Seldes type I & II labral tear, 80% showed femoral head Outerbridge of 0 while 20% showed grade 3. Twenty-one (84%) of these patients were diagnosed with iliopsoas bursitis, and a corresponding 12 (48%) of the patients underwent an iliopsoas release concomitant with labral treatment. A total of 15 (60%) patients showed a ligamentum teres tear, according to both Domb and Villar Classifications. Two-year minimum patient reported outcomes (PROs) showed significant improvement from preoperative values. Conclusion Intra-articular hip pathology should be considered in patients presenting with hip pain following pregnancy and delivery when six weeks of non-operative management fails. These patients should be referred to sports orthopedic surgeons with a sub-specialization in hip pathology for further workup and management.