Delays in Diagnosis Are Common Among Hip Preservation Surgical Candidates: A Systematic Review

Abstract

Purpose

To systematically review the literature on delays in diagnosis or treatment of hip preservation patients.

Methods

A systematic review was performed by searching PubMed, the Cochrane Library, and Embase, from inception to November 2024, to identify any study reporting on delays in diagnosis or treatment of hip preservation patients, that is, patients with femoroacetabular impingement syndrome, hip dysplasia, or femoral torsion abnormalities. The search terms used were as follows: delay AND (diagnosis OR treatment) AND ("femoroacetabular impingement" OR "hip dysplasia" OR "hip arthroscopy" OR "periacetabular osteotomy"). Outcomes reported included demographic characteristics, preoperative duration of symptoms, and patient-reported outcomes.

Results

Twelve articles (1 Level II, 1 Level III, and 10 Level IV) met the inclusion criteria, with a total of 2,883 hips. The mean patient age ranged from 16.4 to 45.0 years, and the overall percentage of male patients ranged from 0% to 56.9%. The mean time from symptom onset to accurate diagnosis for hip preservation patients ranged from 17.2 to 61.5 months across studies. Prior health care providers consulted were largely other orthopaedic surgeons and primary care physicians; each patient consulted with an average of 1.9 to 4.2 providers and received a multitude of alternate diagnoses, imaging assessments, and treatment attempts before presentation to a hip preservation specialist. In studies comparing outcomes between patients with short and long durations of symptoms (i.e., <2 years and >2 years, respectively), significantly worse postoperative patient-reported outcomes were observed in the groups with a longer symptom duration.

Conclusions

Patients presenting with hip preservation pathologies commonly experience delays in diagnosis and/or treatment and consult with multiple health care providers across specialties before receiving an accurate diagnosis and appropriate treatment. In turn, this leads to poorer post-treatment outcomes compared with patients who receive appropriate treatment in a timely manner.

Level of Evidence

Level IV, systematic review of Level II to IV studies.