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Imaging of Hip Pain: From Radiography to Cross-Sectional Imaging Techniques - PubMed

Review

Imaging of Hip Pain: From Radiography to Cross-Sectional Imaging Techniques

Fernando Ruiz Santiago et al. Radiol Res Pract. 2016.

Abstract

Hip pain can have multiple causes, including intra-articular, juxta-articular, and referred pain, mainly from spine or sacroiliac joints. In this review, we discuss the causes of intra-articular hip pain from childhood to adulthood and the role of the appropriate imaging techniques according to clinical suspicion and age of the patient. Stress is put on the findings of radiographs, currently considered the first imaging technique, not only in older people with degenerative disease but also in young people without osteoarthritis. In this case plain radiography allows categorization of the hip as normal or dysplastic or with impingement signs, pincer, cam, or a combination of both.

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Figures

Figure 1
Figure 1

Radiography in normal hip (a), hip dysplasia (b), pincer impingement type (c), and cam (d). Hip in osteoarthritis (e) and septic arthritis (f).

Figure 2
Figure 2

Radiological measurements in pediatric normal (a) and dysplastic hip (b). (c) AP view of a patient with left hip effusion secondary to trauma showing widening of the medial joint space.

Figure 3
Figure 3

Herring lateral pillar classification. Groups A (a), B (b), B/C (c), and C (d). AP radiograph (e), coronal T1 (f), and PD fat sat (g) weighted images showing loss of fat signal of the epiphysis, edema, and cyst formation in femoral metaphysis in a grade C Perthes disease.

Figure 4
Figure 4

(a) X-ray of a 10-year-old child with left hip pain. It was considered normal at emergency despite the widening of the left physis (arrow). Two weeks later epiphysiolysis was evident (b). Despite appropriate surgical reduction (c) osteonecrosis developed and femoral head collapsed 1 month later (d).

Figure 5
Figure 5

(a) Iliopectineal line (red), ilioischial line (yellow), tear drop (blue), acetabular fossa (brown), and anterior (white) and posterior (green) wall of the acetabuli showing mild upper crossover sign. (b) Coxa profunda. (c) Protrusio acetabuli.

Figure 6
Figure 6

(a) Acetabular depth ratio. (b) Center-edge angle of Wiberg. (c) Femoral extrusion index. (d) Tönnis angle. (e) Sharp angle. (f) Crossing ratio. (g) Alpha angle measured in 45° Dunn view. (h) Offset percentage measured in cross-lateral view. (i) Cervical diaphyseal angle.

Figure 7
Figure 7

(a) Axial CT image of pigmented villonodular synovitis eroding the posterior cortex of the femoral neck. (b) Sagittal T2∗ gradient echo image showing a posterior soft tissue mass with hypointense areas secondary to hemosiderin deposition. (c) X-ray film and computed tomography (d) in synovial chondromatosis.

Figure 8
Figure 8

(a) X-ray of a patient with transient osteoporosis of the left hip showing osteoporosis. (b) Coronal stir imaging showing diffuse edema. Scintigraphy (c), sagittal T1 (d), and coronal PD fat sat (e) of a patient with a subchondral fracture of the femoral head with convex shape to the articular surface. Coronal T1 (f) of a patient with avascular necrosis of the femoral head.

Figure 9
Figure 9

Sagittal T1 weighted images showing anterosuperior labral tear (a) and chondral lesion (b). Sagittal CT-arthrography showing posteroinferior chondral injury (c) and coronal CT-arthrography (d) showing ligamentum teres tear.

Figure 10
Figure 10

Stress femoral neck fracture in a young athlete barely visible in X-ray film as a sclerotic line (arrow) (a). Tc 99 scintigraphy shows a band of uptake (b), while T1 (c) and DP fat saturated (d) weighted MR images showed the fracture line and a pattern of edema.

Figure 11
Figure 11

(a) Useful ultrasound measures in neonatal hip sonography, alpha and beta angles. (b) Measurement of femoral head coverage.

Figure 12
Figure 12

(a) Normal ultrasound appearance of the femoral head-neck junction. (b) Joint effusion in transient synovitis of the hip. (c) Flattening of the femoral head in a patient with Perthes disease. (d) Step in the femoral head-neck junction in a patient with SCFE.

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