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Imaging evaluation of the painful hip in adults

Authors
Cecilia Matilda Jude, MD
Shahla Modarresi, MD
Section Editors
Robert H Shmerling, MD
Karl B Fields, MD
Deputy Editors
Monica Ramirez Curtis, MD, MPH
Susanna I Lee, MD, PhD

INTRODUCTION

The hip is a stable, major weightbearing joint with significant mobility. Hip pain has different etiologies in adults and children. In adults, hip pain may be caused by intraarticular disorders such as avascular necrosis (AVN), arthritis, loose bodies, labral tears; periarticular pathology such as tendinitis and bursitis; or extraarticular conditions such as referred pain from lumbar spine, as well as sacroiliac joint and nerve entrapment syndromes.

Imaging modalities used to evaluate adults with hip pain and the appropriateness of particular exams in different clinical scenarios will be reviewed here. The history and physical examination, which are necessary to develop a differential diagnosis prior to the selection of imaging tests; a general review of imaging tests that are used in the evaluation of bone and joint pain; and imaging modalities used to evaluate the hip in children are presented separately. (See "Evaluation of the adult with hip pain" and "Imaging techniques for evaluation of the painful joint" and "Radiologic evaluation of the hip in infants, children, and adolescents".)

TYPES OF IMAGING EXAMS

The modalities available for evaluation of the hip include:

Plain film radiography — Plain film radiography of the hip is used in the initial evaluation of any cause of hip pain, including trauma and sports injuries, suspected avascular necrosis (AVN), arthritis, hip arthroplasty, infection, dysplasia, and tumor [1]. Plain film can also identify causes of referred hip pain, such as sacroiliitis. Plain film may not detect or accurately characterize some hip fractures and bone marrow edema associated with early AVN or early osteomyelitis.

Computerized tomography — Computerized tomography (CT) of the hip without contrast is most useful in the setting of trauma, for preoperative planning, and for evaluation and guiding percutaneous biopsy of tumors. Intravenous contrast is administered for evaluating a septic joint or a soft tissue abscess.

                                     
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Literature review current through: Sep 2017. | This topic last updated: Jun 13, 2017.
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Topic Outline

GRAPHICS