2021 ISAKOS Biennial Congress Paper
No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain
Nathan Varady, MD, MBA, Boston, MA UNITED STATES
Paul F Abraham, BS, Boston, Massachusetts UNITED STATES
Michael Peter Kucharik, BS, Boston, Massachusetts UNITED STATES
Christopher T Eberlin, BS, Boston, MA UNITED STATES
David Freccero, MD UNITED STATES
Eric L. Smith, MD
Scott Martin, MD, Boston, MA UNITED STATES
Department of Orthopaedic Surgery, Massachusetts General Hospital / Harvard Medical School, Boston, MA, UNITED STATES
FDA Status Not Applicable
In this study, we found no evidence that IUDs were associated with hip pain or surgery, which was in contrast to our hypothesis.
The purpose of this study was to investigate the association between IUD usage and hip pain and surgery. We hypothesized that patients with IUDs would have higher rates of hip pain and surgery compared to patients with contraceptive implants.
This was a retrospective cohort study of patients 18-44 years old using either IUDs or subdermal implants for contraception in a large commercial claims database (MarketScan) from 2012-2015. Contraceptive implants were chosen as the active comparator to IUDs given that they are another form of highly-effective, long-acting contraception that require a procedure to initiate. However, they are not local to the pelvic region (typically implanted in the arm), and therefore have no clear mechanism of causing hip pain. All patients had to =12 months of continuous enrollment both before and after contraceptive placement; patients with a history of hip pain or surgery were excluded. Baseline factors including age, region, year of insertion, and contraceptive history were collected. The primary outcome was new hip pain. Secondary outcomes included visiting an orthopaedic or sports medicine provider for a hip complaint, intraarticular hip injection, and arthroscopic hip surgery. Outcomes were analyzed with adjusted Cox-proportional hazard models. The date of contraceptive placement was considered the index date, and patients were then followed until the occurrence of each respective outcome, censoring on database drop out. Sensitivity analyses included additional censoring for contraceptive removal for non-musculoskeletal reasons, as well as comparing copper and hormonal IUDs.
We identified a total of 291,012 patients, 253,772 (87.2%) with IUDs and 37,240 (12.8%) with subdermal contraceptive implants. Implant patients were younger and more likely to live in the South and North Central United States, while IUD patients were common in the West. Additionally, implant became more common with time. Overall, 6108 (2.1%) patients experienced new hip pain in the follow-up period, 891 (0.3%) saw an orthopaedic surgeon or sports medicine specialist for that pain, 317 (0.1%) underwent intraarticular hip injection, and 91 (0.0%) underwent hip arthroscopy. In time-to-event analysis, IUDs (vs. implants) were not associated with increased risk of new hip pain diagnoses (hazard ratio [HR] 0.98, 95% CI 0.89-1.08, p=0.71). In contrast, both increasing age (p<0.001) and year (p=0.006) were associated with increased risk of new hip pain. Similar results were seen for the secondary outcomes, including risk of orthopaedic visits for hip complaints (HR 1.04, 95% CI 0.8-1.36, p=0.75), intraarticular injections of the hip (HR 1.03, 95% CI 0.64-1.66, p=0.89), and hip arthroscopy procedures (HR 1.13, 95% CI 0.54-2.35, p=0.74). Results held in all sensitivity analyses.
Discussion And Conclusion
Identifying and ruling out non-musculoskeletal causes of patients’ symptoms is critical to avoiding unnecessary orthopaedic surgery. While there are many gynecologic pathologies that can occasionally present with symptoms consistent with musculoskeletal hip pain, whether contraceptive IUDs are associated with this clinical presentation was unknown. In this study, we found no evidence that IUDs were associated with hip pain or surgery, which was in contrast to our hypothesis.