FP14.8 Extra-Articular and Pelvic Sources of Hip Pain in Women Referred for Hip Preservation Evaluation: A Case Series

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ID: 331236
2026
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Abstract
Abstract ICLA14 - The Extra-Articular Masterclass: Endoscopic Repairs, Ischiofemoral Fixes, and Complex Alignment, Auditorium A (BMCC Level 1), October 9, 2026, 14:00 - 16:00 Introduction Female patients presenting with hip and groin pain are frequently evaluated for pre-arthritic hip conditions including femoroacetabular impingement, acetabular dysplasia, and labral tears. However, extra-articular pelvic pain generators may mimic intra-articular hip disorders in female patients, potentially leading to misdiagnosis, delays in care, and unnecessary interventions. The purpose of this study is to characterize and distinguish pelvic sources of pain in patients presenting for evaluation of hip joint pathology. Methods Consecutive female patients aged 20-75 years referred for evaluation of hip pain at a tertiary level hip preservation center were identified. Patients determined to have pain due to primary extra-articular pelvic etiologies were included in the series. Clinical characteristics incorporating clinical history, physical examination, diagnostic imaging studies, and appropriate referrals and interventions were included for review. Results In this retrospective study, twenty cases were identified where female patients had intrapelvic etiologies that were found to contribute to their symptoms of hip pain. Eleven patients demonstrated normal hip radiographs (55%) and seven had mild degenerative changes (35%). Two had a normal hip physical exam (10%), with eleven having positive FADDIR (Flexion, Adduction, Internal Rotation, 55%) and seven having tenderness in the groin/adductor (35%). Cross-sectional imaging identified intrapelvic etiologies of pain in eighteen cases (90%) with two being extra-articular but idiopathic (10%). Eight were pelvic congestion (40%), four were endometriosis (20%), three were leiomyomas (15%), and three were ovarian cysts (15%). Eight underwent pelvic floor therapy (40%). Seventeen had gynecologic referral (85%) and four had vascular surgery or interventional radiology referral (20%). Six underwent surgical hip intervention (30%) and twelve underwent surgical extra-articular intervention (60%). Discussion It is essential for hip preservation surgeons to recognize that, while rare, intrapelvic sources of hip pain should be considered in female patients seeking care for pre-arthritic hip conditions. Discordance of clinical history, physical examination, or radiograph findings warrants further workup for an extra-articular source, often including advanced imaging of the abdomen and pelvis and referral to gynecologic and pelvic physical therapy specialists. A thorough history and physical exam complemented by cross sectional imaging can help reach an accurate diagnosis and facilitate appropriate management.
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Authors Laura Garton, Ryan W. Schwertner, Rupert O. Stanborough, Luke Spencer Gardner
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.112
URL
https://doi.org/10.1093/jhps/hnag043.112
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