Middle East presents a special cultural and social set of population whereby traditions dictate the daily life and habitus of general population which in turns effects the biology of people. There is high incidence of hip, knee and feet pathology and non-discogenic lower back pain in relatively young population aged 25-45.

Methodology: A prospective cohort study to investigate the causation and interrelation between the above-mentioned common pathologies. A clinical and radiological review of 3456 patient who attended Orthopaedic service for either of the above pathologies. Two sports and arthroplasty trained surgeons, added further radiology roentgenogram (hips, Knees, feet) + MRI in selected cases and complete clinical examination even if symptoms were in only one of the four anatomical location.

Statistical Methodology: A simple descriptive statistic was used to define the characteristics of the study variables. To establish a relationship between categorical variables, chi-square test used. 

Results: There were 3456 patients. Clinical examination for lower back, hip, knee and feet, along with hip, knee, feet roentgenograph+ MRI in selected cases. 75% of the patients regardless of the anatomical area of symptoms had concomitant (asymptomatic or mild symptomatic) clinical and radiological signs of femoroacetabular impingement, patellofemoral dysplasia, reduced calcaneal pitch and reduced talonavicular coverage. The most common femoroacetabular impingement type was cam 80% (alpha angle 50 degrees and above) with 20 % combined/pincer (lateral center-edge angle 40 degrees and above). Patellofemoral dysplasia showed Dejour type A and C to be most common, reduced calcaneal pitch 17 degrees and lower/talonavicular coverage 7 degrees and higher and negative 4 degrees (convex downward) Meary’s angle were observed. People with predominant lower back pain had higher Alpha and lateral center-edge angle in hips, however many were not symptomatic. Anterion knee pain symptoms with dysplasia were related to feet issues albeit 60 percent were asymptomatic. 

Conclusions: With a high incidence of hip, knee and no neurological/discogenic lower back pathologies in our younger population we were in a unique position to study these pathologies. To our knowledge we are the first who showed a correlation and coexistence of these pathologies in detailed clinical and radiological study, despite patient been unaware of other single or multiple pathologies. We grouped these pathologies as femoroacetabular syndrome to highlight the biomechanical changes in body and increase awareness of Orthopaedic physicians. We attribute hip and knee pathology to cultural habits of prolonged sitting on the floor with extreme him abduction of hip and knee flexion from the formative years to adult life (literature supports this by understanding Hueter-Volkmann Law, Wolff’s Law and Roux’s principle) this intern effects the arches of feet and muscles in lower lumbar spine.

Mujeeb Ashraf, an Irish national Orthopaedic Surgeon trained in the republic of Ireland, later joined major Trauma centers in Oxford and Birmingham UK, developed war related surgical skills  and practicing sports, arthroplasty, pelvic trauma, hip,  war  and sports surgery in Armed Forces Hospital Saudi Arabia.