The Prevalence of Abdominal Hernias in Patients with Symptomatic Femoroacetabular Impingement

Abstract

The purpose of this study was to evaluate the prevalence of abdominal hernias (femoral and inguinal) in patients with symptomatic femoroacetabular impingement (FAI). A consecutive case series of 79 patients (87 hips) with radiologic evidence and clinical symptoms of FAI seen by two of the authors (ML and FDN) where sent for an abdominal ultrasound evaluation to assess for the presence of inguinal or femoral hernia. Patients also underwent diagnostic injection of their hip joints. Basic demographics were collected and radiologic measurements for FAI were performed. The mean age of patients in this series was 29.5 years (range, 12-64 years). Of the 87 hips evaluated (79 patients, 8 with bilateral pathology), 34 (39%) were found to have evidence of femoral (10), inguinal (24) hernias, or both concurrently (3). Twenty-three (23) of these (68%) were male. Six (6) of the patients with hernias, either had no or minimal improvement with intra-articular injection. Two (2) of those were found to insertional tendinosis at the os pubis and four (4) underwent surgical repair of their hernia. There were no statistically significant differences with regards to age, center-edge angle, acetabular index, acetabular version, femoral neck-shaft angle. However, we found a statistically significant lower alpha angle (51.8) in patients with hernias compared to without hernias (57.9, p<0.05). Symptomatic and radiologic significant FAI can occur concurrently with abdominal hernias. In patients who do not respond to intra-articular injection, abdominal ultrasound may be an important diagnostic tool to identify abdominal hernias as source of groin pain similar to FAI symptoms. These patients may require referral to a general surgeon for further treatment. Future studies are aimed at assessing the feasibility of integrating abdominal ultrasound evaluation into the diagnostic workup of FAI and at exploring the difference in alpha angles.