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Editorial
Preventing hip osteoarthritis in athletes: is it really a mission impossible?
  1. Joshua J Heerey1,
  2. Pim van Klij2,
  3. Rintje Agricola3,
  4. Hendrik P Dijkstra4,5,
  5. Lindsey Plass6,7,
  6. Kay M Crossley1,
  7. Joanne L Kemp1
  1. 1 La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
  2. 2 Department of Sports Medicine, Isala Hospital, Zwolle, Overijssel, The Netherlands
  3. 3 Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
  4. 4 Medical Education Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  5. 5 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  6. 6 Plass PT & Performance, Chicago, Illinois, USA
  7. 7 The University of Chicago Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr Joshua J Heerey, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia; j.heerey{at}latrobe.edu.au

https://doi.org/10.1136/bjsports-2023-107584

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    Hip osteoarthritis (OA) in athletes is important to acknowledge, with early hip OA associated with elite-level high joint impact sports, such as football, ice hockey and handball.1 Current management of hip OA is largely reactive (when OA disease is established and irreversible). Identifying athletes at risk of, or with early-stage hip OA, may improve treatment success and reduce disease burden. Clinicians and researchers need to understand the natural history of OA in active populations, risk factors for early hip OA and whether OA in athletes can be prevented. In this editorial, focussing on elite athletes, we aim to describe the natural history of hip OA, consider the role of primary cam morphology in hip OA development and provide clinical and research recommendations for the prevention of hip OA.

    The natural history of hip OA in athletes

    Understanding the natural history of hip OA across the lifespan (figure 1), could empower clinicians and athletes/patients to prioritise appropriate evidence-based interventions (eg, education, clinician-led incremental exercise rehabilitation or surgery) for better hip health:

    1. Adolescence: Changes in articular cartilage composition—a biomarker of early-stage OA—are evident in elite adolescent football players, possibly affecting its tolerance to high joint loads and increasing susceptibility to pathological change.2 This concept is supported by a recent longitudinal study of adolescent athletes where cartilage damage increased over 24 months.3 Primary cam morphology develops due to load-related femoral capital growth plate changes during maturation—from …

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    Footnotes

    • X @JHeerey, @RintjeAgricola, @DrPaulDijkstra, @LindseyPlassDPT, @kaymcrossley, @JoanneLKemp

    • Correction notice This article has been corrected since it published Online First. The fifth affiliation has been updated.

    • Collaborators Not applicable.

    • Contributors All authors contributed to the conception and design of the editorial, writing and revising the manuscript and final approval of the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.