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Twenty-Year Systematic Review of the Hip Pathology, Risk Factors, Treatment, and Clinical Outcomes in Artistic Athletes—Dancers, Figure Skaters, and Gymnasts

Bolia, Ioanna, MD, MSc*; Utsunomiya, Hajime, MD, PhD*; Locks, Renato, MD*; Briggs, Karen, MPH, MBA*; Philippon, Marc, J., MD*,†

Clinical Journal of Sport Medicine: January 2018 - Volume 28 - Issue 1 - p 82–90
doi: 10.1097/JSM.0000000000000440
Critical Review

Objective: To identify (1) the predominant level of evidence of the clinical studies regarding the hip pathology, risk factors, treatment, and clinical outcomes in artistic athletes (dancers, figure skaters, and gymnasts) (2) the most commonly reported hip pathology, risk factors, treatments, and clinical outcomes in dancers, figure skaters, and gymnasts.

Methods: To conduct this systematic review PubMed, EMBASE, and Scopus databases were searched for relevant studies and pertinent data were collected from the eligible articles. Included were studies which reported hip injuries in artistic athletes, the risk factors, treatment, and/or the clinical outcomes. We excluded case reports or irrelevant studies. No meta-analysis was performed because of study heterogeneity. The methodical index for nonrandomized studies (MINORS) criteria were used for quality control.

Main Results: Thirty-eight studies were included in the analysis. The mean MINORS score was 13.6 ± 4.6 points indicating fair quality of evidence of the included articles. The predominant level of evidence was level IV. Chondrolabral pathology and muscle injuries were the most commonly reported pathologies. We found only 2 risk factor analysis studies; however, many studies reported risk correlation between artistic sports or imaging findings and hip pathology. Treatment strategies were reported in only 7 studies, clinical outcomes are significantly underreported.

Conclusion: Chondrolabral pathology was the most commonly reported hip pathology in artistic athletes, however, prospective cohort studies are necessary to really understand these injuries and their associated risk factors. The lack of clinical outcomes is significant and future data collection is required to assess the effectiveness of the various treatments.

*Steadman Philippon Research Institute, Vail, Colorado; and

The Steadman Clinic, Vail, Colorado.

Corresponding Author: Marc J. Philippon, MD, Steadman Philippon Research Institute, The Stedman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657 (

M. J. Philippon receives research support from National Institute of Health, National Institute of Arthritis and Musculoskeletal ans Skin Diseases, National Institute of Aging, Smith and Nephew Endoscopy, Ossur, Arthrex, Siemens and Royalties from Bledsoe, ConMed Linvatec, DonJoy, SLACK Iinc., Elsevier. M. J. Philippon is stockholder of Arthrosurface, MJP Innovations, LLC, MIS, Vail Valley Medical Center-Governing. The remaining authors report no conflicts of interest.

Received December 30, 2016

Accepted March 16, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.