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Title: Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging
Austin Authors: Buikstra, Joel Glenn;Fary, Camdon;Tran, Phong
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Orthopaedic Surgery, Western Health, Footscray, Victoria, Australia
Issue Date: 21-Mar-2017
Publication information: BMC Musculoskeletal Disorders 2017; 18: 120
Abstract: BACKGROUND: Patients with groin, hip and pelvic pain but normal findings on MRI and minimal changes on x-ray can be a diagnostic problem. This paper looks at the arthroscopic findings of patients who have had hip pain and a positive response to an intra-articular anaesthetic but have non-contributory imaging. We hypothesized that standard MRI's were missing significant pathology and if there was a response to intra-articular local anaesthesia, pathology found during arthroscopy was likely. METHODS: A retrospective review of all hip arthroscopies performed from March 2011 to January 2015 by two orthopaedic surgeons specializing in hip arthroscopy was conducted to identify patients with clinically suspected intra-articular hip pathology despite a normal MRI report and X-ray. Clinical suspicion of intra-articular hip pathology was confirmed with a positive response to a fluoroscopically guided intra-articular injection of local anaesthetic and corticosteroid. Pathologic findings were collated from the standardised operative notes. RESULTS: Fifty-three hip arthroscopies performed in 51 patients met the inclusion criteria from a total of 1348 hip arthroscopies performed over a 46-month period. All but one of the 53 (98%) hips had arthroscopically confirmed pathology. Mean patient age was 32.5 years [15 to 67 years] with 40 (78%) females and 11 (22%) males. 92.5% of the hips (49/53) were FADIR (flexion, adduction and internal rotation) positive on clinical examination, giving this test a positive predictive value of 98% (95% CI: 89.31 to 99.67%) for intra-articular pathology. CONCLUSIONS: In patients with a normal MRI without contrast and a positive response (relief of pain) to an intra-articular injection that failed conservative management, there is a 98% chance of intra-articular hip pathology being discovered on hip arthroscopy.
DOI: 10.1186/s12891-017-1485-5
Journal: BMC Musculoskeletal Disorders
PubMed URL:
Type: Journal Article
Subjects: Hip arthroscopy
Image-guided injection
Intra-articular hip pathology
Magnetic Resonance Imaging
Appears in Collections:Journal articles

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