and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement

Kahlenberg CA, Han B,
Patel RM, Deshmane PP, Terry MA.  Orthopaedic Journal of Sports Medicine
2014 2(3):2325967114523916.

Home Message: Diagnosing labral tears with femoroacetabular impingement can be
slow and expensive, it is important for health care professionals to quickly
recognize and manage the symptoms.

impingement (FAI) and labral tears are the most common causes of non-arthritic
hip pain in an active population.  Diagnosis
of these conditions is often delayed as we try to rule out other diagnoses;
but, this delay could be costly and expose a patient to prolonged periods of
pain and increase their risk for long-term adverse health effects. If we had a
better understanding of how patients were evaluated and treated for FAI and
labral tears then this might help us identify strategies to improve patient
care and reduce cost.  Therefore, these
authors set out to determine the average time and money spent by an individual
leading up to a diagnosis of a labral tear associated with FAI.  One hundred consecutive patients who were
diagnosed by a surgeon with a labral lesion associated with FAI (early 2012) were
asked to fill out a questionnaire regarding the course of their hip problems
prior to diagnosis.  The authors excluded
22 individuals who had other injuries (e.g., lumbar spine complaints). Questions
included the length of time experiencing symptoms before visiting a health care
professional, number of and type of health care providers visited, length of
time to diagnosis after initiating care, number and type of imaging tests
obtained, and number and type of symptom management methods used.  The authors estimated the costs for diagnostic
testing and health care provider visits by using the Medicare Technical
Component and Medicare (2012 costs).  On average,
a patient visited 4 health care providers before being seen by a surgeon, at an
average cost of $315.05 per patient.  A
patient on average underwent 3.4 diagnostic tests to obtain the diagnosis at an
average cost of $837.01.  Patients
generally received a labral tear diagnosis 32.0 months after the onset of
symptoms.  In that time, a patient on
average tried 3.1 conservative treatments for an average cost of $1375.44.

These results highlight
an unsettling trend in the current diagnosis and treatment of FAI.  Even more alarming is that the cost
associated with diagnosis and treatment of labral tears with FAI is likely
underestimated by this study because they relied on Medicare payments instead
of actual hospital charges.  Based upon
Medicare expense data (2012), the minimum cost to diagnose a labral tear
(requires AP pelvis and lateral hip radiograph, MR arthrogram, and a visit to
an orthopaedic surgeon) is $690.62.  In
comparison, the average cost prior to diagnosis in this study was $2456.97,
nearly 3 times higher.  It will be
interesting to see if these findings are true in other areas of the United
States. It is important for us to more efficiently diagnose and effectively
treat FAI and labral tears.  Some of the
most commonly reported symptoms were groin pain and the need to limit running
activities.  Other problematic activities
include entering/exiting a vehicle, prolonged sitting, and stair climbing.  These signs may be common to multiple different
orthopaedic injuries, which may be a contributing factor to length to
diagnosis.  However, this study supports
that an individual exhibiting these prolonged signs would likely benefit from
earlier attempts to rule out labral involvement. 

for Discussion: How might this information factor into your clinical practice
when dealing with similar patients?  Have
your heard similar complaints from patients regarding unclear diagnoses?  If so, how have you handled this situation?

Written by:  Meghan Maume Miller
Reviewed by: Jeffrey

Kahlenberg, C., Han, B., Patel, R., Deshmane, P., & Terry, M. (2014). Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement Orthopaedic Journal of Sports Medicine, 2 (3) DOI: 10.1177/2325967114523916