Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

R. Wejnold Jørgensen1, *, C. Dippmann2, L. Dahl1, J. Stürup1
1 Department of Orthopedics, National University Hospital, Rigshospitalet, Copenhagen, Denmark
2 Section for Sports Traumatology M51, Department of Orthopedic Surgery, Bispebjerg Hospital, Copenhagen, Denmark

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Creative Commons License
© Jørgensen et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopedic, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, OE, Denmark; Tel: + 45 4025 1150; E-mail:



The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option for the right patient can be challenging in patients with non-arthritic hip pain.


The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment option for each clinical condition.

Material and Methods:

A review of the literature was performed using Public Medline searches of MeSH terms combined with synonyms for femoroacetabular impingement, acetabular retroversion, periacetabular osteotomy and hip arthroscopy.


Radiographic findings associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg’s lateral center-edge angle (CE-angle) together with Leqeusne’s acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis, however unsatisfying results are documented following joint preserving surgery with a Tönnis index >1. Furthermore, ischial spine sign in combination with the posterior wall sign indicates total acetabular retroversion prone to periacetabular osteotomy in contrast to focal retroversion prone to hip arthroscopy. These findings were used creating a treatment algorithm for intraarticular pathologies in patients with longstanding hip pain.


Based on the radiographic findings, the algorithm presented in this study can be a helpful tool in the decision-making for the treatment of patients with non-arthritic hip pain, suspect for intraarticular pathologies.

Keywords: Acetabular retroversion, Femoro-acetabular impingement, Hip arthroscopy, Non-arthritic hip pain, Periacetabular osteotomy, Treatment algorithm.