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No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

Christopher T Eberlin, BS
UNITED STATES

No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

Nathan Varady, MD, MBA, UNITED STATES Paul F Abraham, BS, UNITED STATES Michael Peter Kucharik, BS, UNITED STATES Christopher T Eberlin, BS, UNITED STATES David Freccero, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES Scott D Martin, MD, UNITED STATES

Department of Orthopaedic Surgery, Massachusetts General Hospital / Harvard Medical School, Boston, MA, UNITED STATES

2021 Congress Abstract Presentation 5 minutes Not yet rated

Anatomic Location

Hip / Groin / Thigh

Anatomic Structure

Cartilage

Diagnosis Method

Physical Examination

Sports Medicine

Epidemiology

Treatment / Technique

Arthroscopy

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Summary: In this study, we found no evidence that IUDs were associated with hip pain or surgery, which was in contrast to our hypothesis.

Introduction

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.

Methods

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.

Results

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.

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Assessing Risk Of Osteonecrosis Of The Hip Following Intraarticular Injections: Hyaluronic Acid Versus Corticosteroid Abstract Presentation 5 minutes Nathan Varady, MD, MBA, UNITED STATES Ahab Chopra, BA, UNITED STATES Paul F Abraham, BS, UNITED STATES Michael Peter Kucharik, BS, UNITED STATES Christopher T Eberlin, BS, UNITED STATES David Freccero, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES Scott D Martin, MD, UNITED STATES
Persistent Post-Operative Opioid Use Following Hip Arthroscopy Is Common And Is Associated With Pre-Operative Opioid Use And Age ePoster Presentation Ryan M. Degen, MD, FRCSC, CANADA J. Andrew McClure, MSc, CANADA Britney Le, MSc, CANADA Blayne Welk, MD, CANADA Jacquelyn Marsh, PhD, CANADA
Mid-Term Outcome and Strength Assessment after Proximal Rectus-Femoris-Refixation in Athletes ePoster Presentation Maximilian Hinz, MD, GERMANY Stephanie Geyer, MD, GERMANY Felix Winden, Cand Med, GERMANY Alexander Braunsperger, B.Sc., GERMANY Florian Kreuzpointner, PhD, GERMANY Benjamin Daniel Kleim, MBBS, MD, MRes, GERMANY Andreas B. Imhoff, MD, Prof. Emeritus, GERMANY Julian Mehl, MD, GERMANY
Defining Sex-Based Outcomes Following Hip Arthroscopy In Patients With Borderline Hip Dysplasia. ePoster Presentation Benjamin Saks, MD, UNITED STATES James Fox, BBA, UNITED STATES Jade S Owens, BS, UNITED STATES Andrew Jimenez, MD, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Payam William Sabetian, MD, GUATEMALA Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Results After Arthroscopic Treatment Of Iliopsoas Impingement After Total Hip Arthroplasty ePoster Presentation Wolfgang Miehlke, MD, GERMANY Christian Sobau, MD, GERMANY Alexander Zimmerer, MD, GERMANY
Outcomes Of Revision Hip Arthroscopy Are Unaffected By Intraoperative Findings: A Matched Cohort Study ePoster Presentation Hari Krishna Ankem, MD, UNITED STATES Samantha Diulus, BS, UNITED STATES Cynthia Kyin, BA, UNITED STATES Jacob Shapira, MD, UNITED STATES Philip Joseph Rosinsky, MD, UNITED STATES Mitchell Meghpara, MD, UNITED STATES Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Treatment of Bilateral Hip Femoroacetabular Impingement: Simultaneous or Staged? Abstract Presentation 5 minutes Gen Lin Foo, MD, SINGAPORE Catherine J. Bacon, PhD, MSc, BSc, BPhed(Hons), NEW ZEALAND Matthew J. Brick, MBChB, FRACS, NEW ZEALAND
Labral Preserving Hip Arthroscopy and Bone Marrow Aspirate Injection for Patients with Symptomatic Labral Tears and Early Degenerative Changes Abstract Presentation 7 minutes Molly A Day, MD, UNITED STATES Kyle Hancock, MD, UNITED STATES Ryan S. Selley, MD, UNITED STATES Reena Olsen, BS, UNITED STATES Anil S. Ranawat, MD, UNITED STATES Benedict U. Nwachukwu, MD, MBA, UNITED STATES Bryan T. Kelly, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Efficacy Of Enoxaparin As A Thromboprophylactic Agent In Major Lower Limb Orthopedic Surgeries. ePoster Presentation Raghavendra Raju, MBBS,MS, INDIA Prasad Soraganvi, MBBS, MS, DNB, MRCS, SICOT-dip, INDIA
Sex- And Age-Based Differences In Outcomes And Survivorship Following Primary Hip Arthroscopy At Short And Mid-Term Follow-Up: A Comparative Analysis ePoster Presentation David R. Maldonado, MD, UNITED STATES Jade S Owens, BS, UNITED STATES Cammille Go, BA, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
The Surgeon Mentor Program: Outcomes of Total Hip Arthroplasty via the Direct Anterior Approach ePoster Presentation Christopher J. Wilson, A/Prof, MBChB, MRCS, FRACS, PhD, AUSTRALIA Melinda Jiang, MD, AUSTRALIA Mark Inglis, FRACS BMBS B Med Sci FOrthoA, AUSTRALIA David Morris, MD, AUSTRALIA Nathan Eardley-Harris , MBBS, MClinSc, AUSTRALIA
Can Hip Pain Be Treated With Tibial Malrotation Correction? Abstract Presentation 5 minutes Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, UNITED KINGDOM Mohamed Zubair Farook, MBBS, D.Ortho, FRCS (Orth), UNITED KINGDOM Rajiv Kaila, MRCS, MSc, MFSEM(UK), FEBOT, UNITED KINGDOM Tom CB Pollard, MD, FRCS (Tr & Orth), UNITED KINGDOM Antonio J. M. D. Andrade, MB BS, M.Sc., FRCS(Tr&Orth), UNITED KINGDOM
What is the Association Between Anterior Cruciate Ligament Reconstruction and Femoroacetabular Impingement Surgery? An Analysis of Over 18,000 Hip Arthroscopies Abstract Presentation 6 minutes Clare Wise, BS , UNITED STATES Marc R. Safran, MD, Prof., UNITED STATES Jeremy N. Truntzer, MD, UNITED STATES Robin Kamal, MD, MBA , UNITED STATES
Cannabis Use Is Not Associated With Increased Opioid Use Or Costs After Hip Arthroscopy Abstract Presentation 5 minutes Christopher L. McCrum, MD, UNITED STATES Jacob Thomas Wood, BS, UNITED STATES Senthil Sambandam, MD, UNITED STATES
Alpha Angle More Useful Than Femoral Head-Neck Offset to Predict Intra-Articular Damage in Patients with FAI Undergoing Hip Arthroscopy Abstract Presentation 5 minutes Jacob Shapira, MD, UNITED STATES Jade S Owens, BS, UNITED STATES David R. Maldonado, MD, UNITED STATES Philip Joseph Rosinsky, MD, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Bezalel Peskin, MD, ISRAEL Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Endoscopic Iliopsoas Lengthening For Treatment Of Recalcitrant Iliopsoas Tendinitis After Total Hip Arthroplasty Abstract Presentation 5 minutes Marc R. Safran, MD, Prof., UNITED STATES John Carlo Bonano, MD, UNITED STATES Christopher Jamero, MA, ATC, UNITED STATES Nicole Alexandria Segovia, BA, UNITED STATES James I. Huddleston, MD, UNITED STATES
Are Femoral And Tibial Derotation Osteotomies Effective In Improving Hip And Knee Pain And Function? Abstract Presentation 5 minutes Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, UNITED KINGDOM Mohamed Zubair Farook, MBBS, D.Ortho, FRCS (Orth), UNITED KINGDOM Rajiv Kaila, MRCS, MSc, MFSEM(UK), FEBOT, UNITED KINGDOM Tom CB Pollard, MD, FRCS (Tr & Orth), UNITED KINGDOM Antonio J. M. D. Andrade, MB BS, M.Sc., FRCS(Tr&Orth), UNITED KINGDOM
Can Intra-Articular Gadolinium Confound The Results Of A Diagnostic Anesthetic Injection In Young Patients With Hip Pain? Abstract Presentation 5 minutes Daniel Curtis, MD, UNITED STATES William Michael Pullen, MD, UNITED STATES Christopher Jamero, MA, ATC, UNITED STATES Marc R. Safran, MD, Prof., UNITED STATES
Predicting Dissatisfaction Following Total Hip Arthroplasty Using A Bayesian Model Averaging (Bma) Approach: Results From The Australian Arthroplasty Clinical Outcomes Registry (Acorn) ePoster Presentation Jan Peter Van Meirhaeghe, MD, BELGIUM Rob Molnar, MBBS, AUSTRALIA Sam Adie, BSc(Med) MBBS MSpMed MPH PhD FRACS, AUSTRALIA

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No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

Introduction

Methods

Results

Discussion And Conclusion

More 2021 Congress Hip Abstract Presentations

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No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

Introduction

Methods

Results

Discussion And Conclusion

More ISAKOS 2021: Global Content