X-ray of hip pain

Author: Mikael Häggström

This article focuses on long-term hip-pain rather than fractures (see X-ray of fractures).

Contents

Planning

Choice of investigation

Projectional radiography ("X-ray") of hip pain is the first imaging technique of choice, not only in older people with suspected osteoarthritis but also in young people without any such suspicion. In this case plain radiography allows categorization of normal anatomy versus hip dysplasia, or with impingement signs, pincer, cam, or a combination of both.

Also consider the possibility of inguinal hernia.

It is performed as an X-ray of the hip joint.

Evaluation

The main focus is on the joint, but also includes an overview of the projected pelvic bones and femur.

Potential findings in adults

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  Normal hip

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  X-ray in pincer impingement type of hip dysplasia, showing a pincer at the lateral part of the acetabulum

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  X-ray of cam, with bulging at the lateral part of the neck of the femur

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  Hip in osteoarthritis with joint space narrowing and sclerosis.
  See X-ray of osteoarthritis of the hip joint

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  Septic arthritis, similar to osteoarthritis but occurs faster and is generally more erosive.

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  X-ray of synovial chondromatosis, with a calcified cartilaginous chondroma inferiorly.

Potential findings in children

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  Legg–Calvé–Perthes disease occurs mainly between the ages of 4 and 10 years, with osteonecrosis of the left head of the femur
  See X-ray of Legg–Calvé–Perthes disease

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  Slipped capital femoral epiphysis usually affect 11- to 14-year-old patients.

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  Left hip effusion, showing widening of the medial joint space.

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  Hip dysplasia, with insufficient acetabular coverage of the head of the femur.
  See X-ray of hip dysplasia