Degenerative disease

of hip joint.
Radiological diagnosis
Contents

 Anatomy
 Radiologic anatomy
 Arthrosis
Radiograph
Radiograph
Radiograph
Radiograph
Anterior-
posterior
radiograph
of pelvis
Adjustable
radiograph of
pelvis
Anterior-posterior radiograph
of hip joint
Oblique
radiograph of the
hip
 CT

 3D surface
reconstruction
Coronal reconstruction
CT arthrography of hip joint
Metal artifacts
MRI
MRI
US
US
US
US

P M
Bone
scintigraphy
Arthrosis

 Degenerative joint
disease
 Related with age and
body weight(BMI>30)
 Related with chronic
hypomobility and
chronic hypermobility
because of
repetative
movements
Arthrosis

 Primary
 Heberden, Bouchard
nodes in small joints
of the hand
 Spine
 Hip
 Knee
Arthrosis

 Secondary
 Comprises 20 % of all arthroses
 Young patients
 Clear cause
 Trauma

 Calve-Pertes disease –
 osteochondropathy
 Dysplasia et al.
Definition of arthrosis
 There is no united
definition
 Arthrosis is the result of
many diseases of
different etiology, in
which are effected such
structures as
 cartilage
 subchondral bone
 blood vessels,
 synovium,
 capsule and ir
 surrounding muscles
Arthrosis
 Increases metabolism in
bones and cartilages
 Production of tissue
(formation of new
cartilage, osteophytes
e.c.)
 In initial phases
increases amount of
water
 Amount of subchondral
vessels decreases
Joints affected in arthrosis

 Small joints of hands and feet (CMC,

MCP, PIP (Bouchard nodes), DIP
(Heberden nodes), MTP
 Knee joints
 Hip joints
 Intervertebral discs and joints of the
spine
Artrozės pažeidžiami sąnariai
Signs of arthrosis

 Narrowing of joint space because of

injuried cartilage
 Joint space narrows asymmetrically
more in places, where is the maximal
load
 Subchondral sclerosis of the bone
 Formation of osteophytes in the edges of
joints
 Subchondral degenerative cysts
Arthrosis of hip joint

 Joint space narrowing most often seen in

superior part
 Femoral head is dislocated superiorly
and laterally
 Thickening of femoral neck may be seen
 Cysts of acetabulum are called cysts of
Eger
Directions of migration of
femoral head
Radiograph
 Radiograph
 Joint space ↓
 Significant migration
superiorly of
femoral head = loss
of cartilage
 Subchondral
sclerosis
 Significant
osteophytes
 Large Eger cyst in
upper part of
acetabulum
 Slight flattening of
upper part of
femoral head
 CT

Axial CT slice with bone

window of upper part
of the joint
 joint narrowing
 osteophyte formation
 subchondral cysts
Stages of arthrosis

 I – small osteophytes
 II – osteophytes, slightly narrowed joint
space
 III – large osteophytes, subchondral
sclerosis, significantly narrowed joint
space
 IV – mutiple osteophytes, hardly visible
joint space(but still visible), deformation
of the joint
Arthrosis
Arthrosis
Arthrosis in CT images

 CT is performed in doubtful cases

 Unclear position of femoral head
(anteversion, rotation of pelvis et c.)
 Calcifications in the joint
 Before surgery
CT – degenerative changes
and free fragments
Arthrosis in MRI images

 Becomes more popular, because gives

much information about cartilage and
soft tissues
 T1 and T2 sequences are performed
 It’s important to have images of any
sequences of both joints (for
comparison)
 MRI is made in two planes with different
sequences
MR arthrography (T1 sequences)
of the left hip joint. Complete tear
of acetabulur edge
Arthrosis in
US images
Nuclear medicine
 99mTc-MDP – buildup in right hip joint
 X-ray – significant coxarthrosis
Course of diagnostics
 The diagnosis of hip OA starts with a complete
history and physical examination by your
doctor.
 X-rays will be required to determine the extent
of the cartilage damage and suggest a possible
cause for it.
 Other tests may be required if there is reason to
believe that other conditions are contributing to
the degenerative process. Magnetic resonance
imaging (MRI) may be necessary to determine
whether hip condition is caused by AVN.
 Blood tests may be required to rule out
systemic arthritis or infection in the hip.
Differential diagnostics
WHAT CAUSES A PAINFUL HIP?
 Osteoarthritis
 Inflammatory Arthritis
 Avascular Necrosis
 Fracture
 Childhood Hip Problems
 Infection
 Spinal pathology
 Abdominal/pelvic organs pathology
Differential Diagnosis
Differential Diagnosis of Hip or Leg Pain
 Bone - fracture, avascular necrosis of the femoral head,
primary neoplasm, metastatic disease
 Joint - osteoarthritis, inflammatory arthritis, septic arthritis,
crystalloid arthritis, osteoid osteoma, osteitis pubis,
acetabular tear
 Muscle, tendon, bursa - contusion, iliotibial band
syndrome, muscle strain, tendonitis, trochanteric bursitis,
iliopsoas bursitis, pyriformis syndrome, myositis
ossificans
 Spine, neuropathic source - Disorders of the lumbar disc,
lumbar spinal stenosis, sciatica, coccygodynia, meralgia
paresthetica
 Others - Hernia, abdominal pathology, pelvic pathology,
referred pain from knee, ankle, or foot
Spectrum of hip joint pathology

 Normal hip joints

 Spectrum of hip joint pathology(1)

 Osteoarthritis/deformative osteoarthrosis/coxarthrosis
 Spectrum of hip joint pathology(2)

 Rheumatoid arthritis
 www.learningradiology.com
 Spectrum of hip joint pathology(2)
Septic arthropathy of right hip joint with disappearance of joint space
and disappearance of subchondral line of acetabulum roof – septic
arthritis
Coronal STIR sequence shows significant
amount of fluid and perisynovial edema on the
left. Increased bone marrow signal in
acetabulum and proximal part of femoral bone
shows concomitant osteomyelitis
ARTHRITIS

 Narrowing of joint
space
 Reduced density of
subchondral plates
 Osteoporosis
 Disappearance of
joint space –
ankylosis (in late
stages)
ARTHRITIS
ANKYLOSIS
 Spectrum of hip joint pathology(3)

 Avascular necrosis of femoral head

Spectrum of hip joint pathology(3)

 Legg-Calve-Perthes disease – idiopathic avascular

necrosis of femoral head in young children
 Spectrum of hip joint pathology(3)

 Progression of Legg-Calve-Perthes disease

 Spectrum of hip joint pathology(5)

 Pigmentary villonodular synovitis

 Spectrum of hip joint pathology(6)

 Intertrochanteric fracture
 Spectrum of hip joint pathology(7)

 Subcapital fracture
Spectrum of hip joint pathology(8)

 Acetabular protrusion – Paget disease

 Spectrum of hip joint pathology(9)

 Epiphyseolysis of left femoral bone – in teenagers with overweight. It is slow fracture

through the proximal femoral growth line. In this case remodelation takes place.
 Spectrum of hip joint pathology(10)

 Mts in prostate Ca
Spectrum of hip joint pathology(11)

 Chondrocalcinosis
Spectrum of hip joint pathology(12)

Congenital hip dysplasia

 Spectrum of hip joint pathology(13)

 Fluid in hip joint

 Synovitis of hip joint

 Widening of joint space of right hip joint without changes in bones

 Widening in 1mm or more in adult age shows increased amount of fluid
 In patients with hip pain the radiograph of pelvis should be done in order to evaluate
and to compare both hip joints
Thank you