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Research ArticleArticle
Open Access

Prevalence of Femoroacetabular Impingement Syndrome among Young and Middle-aged White Adults

Jacek A. Kopec, Qian Hong, Hubert Wong, Charlie J. Zhang, Charles Ratzlaff, Jolanda Cibere, Linda C. Li, Helen Prlic, David R. Wilson, Bruce B. Forster and John M. Esdaile for the IMPAKT-HIP Study Team
The Journal of Rheumatology November 2019, jrheum.190345; DOI: https://doi.org/10.3899/jrheum.190345
Jacek A. Kopec
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Qian Hong
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Hubert Wong
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Charlie J. Zhang
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Charles Ratzlaff
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Jolanda Cibere
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Linda C. Li
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Helen Prlic
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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David R. Wilson
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Bruce B. Forster
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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John M. Esdaile
From the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; the Department of Medicine, and the Department of Physical Therapy, and the Department of Orthopaedics, and the Department of Radiology, University of British Columbia, Vancouver, British Columbia; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Centre and College of Medicine, University of Arizona, Tucson, Arizona, USA. The study was supported by Grant No. PAF-107513 from the Canadian Institutes of Health Research. J.A. Kopec, MD, PhD, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada; H. Qian, MSc, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital; H. Wong, PhD, School of Population and Public Health, University of British Columbia; C.J. Zhang, MD, Department of Family Medicine, University of Calgary; C. Ratzlaff, PhD, Arthritis Centre and College of Medicine, University of Arizona; J. Cibere, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada; L.C. Li, PhD, Department of Physical Therapy, University of British Columbia, and Arthritis Research Canada; H. Prlic, MA, Arthritis Research Canada; D.R. Wilson, PhD, Department of Orthopaedics, University of British Columbia; B.B. Forster, MD, Department of Radiology, University of British Columbia; J.M. Esdaile, MD, Department of Medicine, University of British Columbia, and Arthritis Research Canada. Address correspondence to Dr. J.A. Kopec, School of Population and Public Health, University of British Columbia, Senior Scientist, Arthritis Research Canada, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: jkopec@arthritisresearch.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication October 18, 2019.
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Abstract

Objective The purpose of the study was to determine the prevalence of femoroacetabular impingement syndrome (FAIS) in white adults 20 to 49 years of age.

Methods Participants were white men and women aged 20–49 years, recruited through random digit dialing from the population of Metro Vancouver, British Columbia, Canada. Participants filled out a self-administered questionnaire and underwent a physical examination and radiographs of both hips. FAIS was defined as a combination of hip symptoms, physical signs of impingement, and radiological findings of cam or pincer morphology as recommended by the Warwick Agreement. All analyses were weighted to reflect the population from which the sample was drawn.

Results Data were obtained for 500 participants. In the study population, 48.9% were males and the age distribution was 32.2%, 31.4%, and 36.4% in the groups 20–29, 30–39, and 40–49 years, respectively. The physical signs of impingement correlated significantly with symptoms, but there was no significant association between either symptoms or physical examination with radiographic findings. FAIS on either side was found in 3.0% (95% CI 1.5–4.5) of the population.

Conclusion In this study, FAIS was present in 3% of whites aged 20–49 years. Further research is needed to develop consistent criteria for assessing hip symptoms, physical signs, and hip joint morphology, and to better understand the relationships between them.

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Prevalence of Femoroacetabular Impingement Syndrome among Young and Middle-aged White Adults
Jacek A. Kopec, Qian Hong, Hubert Wong, Charlie J. Zhang, Charles Ratzlaff, Jolanda Cibere, Linda C. Li, Helen Prlic, David R. Wilson, Bruce B. Forster, John M. Esdaile
The Journal of Rheumatology Nov 2019, jrheum.190345; DOI: 10.3899/jrheum.190345

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Prevalence of Femoroacetabular Impingement Syndrome among Young and Middle-aged White Adults
Jacek A. Kopec, Qian Hong, Hubert Wong, Charlie J. Zhang, Charles Ratzlaff, Jolanda Cibere, Linda C. Li, Helen Prlic, David R. Wilson, Bruce B. Forster, John M. Esdaile
The Journal of Rheumatology Nov 2019, jrheum.190345; DOI: 10.3899/jrheum.190345
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