Short report: Ex-professional association footballers have an increased prevalence of osteoarthritis of the hip compared with age matched controls despite not having sustained notable hip injuries

G J Shepard, A J Banks and W G Ryan

British Journal of Sports Medicine

Volume 37, Issue 2, 2003, Pages 80-81

A group of researchers from Lancashire, UK are examining the incidence of osteoarthritis (OA) of the hip joint in ex-professional association footballers. Part of the pilot work of this study examined the prevalence of hip joint OA in association football coaches, who were ex-professional players. These coaches were asked to complete a questionnaire to ascertain whether or not they had hip joint OA. The findings of the returned questionnaires were compared with a control group of age matched subjects and it was found that the ex-professional footballers had a significantly higher prevalence of OA of the hip.

In keeping with previous research, this short report indicated that there may be an increased incidence of OA hip in ex-professional players. Another interesting finding of the report, by Shepard et al, was that those ex-professionals who reported having hip OA didn't report any previous significant hip injury or hip surgery. This would suggest that the activity of playing football at a professional level pre-disposes those involved to OA of the hip. The authors postulate that this may be due to repetitive minor hip joint injuries rather than soft tissue injuries.

Although this study raises interesting questions, it is not possible to extrapolate the findings because of methodological weaknesses. While the control group were examined with x-ray evidence, the ex-players were not. The ex-players merely replied to a questionnaire interview, making the findings dependent upon their recollections. While they may be reliable at reporting whether they had previously been diagnosed with OA of the hip, or indeed undergone previous surgery, they may not be able to reliably recollect all previous hip and groin injuries they sustained during their career. As the authors did not examine previous medical records, it is not possible to rule out previous hip and groin injuries as a precursor to later OA.

More evidence is coming to light that soft tissue injuries around the hip joint are increasing in professional football players. This increased incidence seems largely to be due to better diagnosis, which has been aided by advances in surgical technique and knowledge. Hip arthroscopy has shown that injuries to the acetabular labrum, with subsequent articular cartilage damage, are relatively common in professional players. Richard Villar, the orthopaedic specialist who pioneered the hip arthroscopy technique, feels that in years gone by, labral injuries went undiagnosed or were incorrectly classified as 'groin strains'. These injuries can perhaps explain the increased incidence of hip OA in ex-professionals.

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