Common Hip Xray Findings - Interpretation

Question 1

Structure of presentation
Introduction
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Answer 1

I have the hip Xray of (patient name, DOB), taken on (date, time) who presented with a (duration) history of (PC)

Do we have any previous imaging?

This is a

• AP - ilium to femoral shaft
• lateral -

Question 2

1. Adequacy and alignment

Answer 2

Adequacy - above iliac crests-1/3 femoral shaft

Alignment - coccyx tip and pubic symphysis at midline

Question 3

2. Bones
   - femur
   - pelvis

Answer 3

Cortical outline - breaks?
Bony texture - disruption?
Symmetry?

Femur - head, neck, greater/lesser trochanters, proximal
-Shenton’s line

Intracapsular - above trochanteric line
Extracapsular - below trochanteric line

Pelvic bones - Ischium, ilium, pubis, sarcrum

Rings will be broken in 2 places

• pelvic brim
• obturator foramen 2x

Bony mets - mix of sclerotic and lytic areas

Question 4

3. Cartilaginous joints
   - acetabulum
   - pubic symphysis

Answer 4

Acetabulum

• location of femoral head in relation
• joint space

Pubic symphysis

• joint space - should be narrow
• joint end plates - should be smooth, regular

Question 5

4. Soft tissue

Answer 5

Effusion - hyperdensity, fluid level
Periosteal reaction - irritation from fracture healing, tumour
Calcification of soft tissues
Foreign bodies

Question 6

OA

• findings
• presentation
• investigations
• management

Answer 6

Loss of joint space
Osteophytes
Sclerotic lesions
Subchondral cysts

Pain worse on mv
Improved by rest
Morning stiffness U30mins

Question 7

Sacroilitis from AS

• findings
• presentation
• investigations
• management

Answer 7

Sclerosis of joint endplates
Irregular joint endplates
Wide joint spaces

Lower back, buttock pain
Inflammatory arthritis presentation

Question 8

Hip dislocation

• findings
• presentation
• investigation
• management

Answer 8

Complete disruption of SL
INT ROTATION, ADDUCTED
Sup to acetabulum
Soft tissue opacification - inflammation

Post more common than ant

• severe pain
• popping
• NWB
• altered sensation to lower limb
• int rotation, adduction, short limb

Lateral HXR
CT

Reduction

• recurrent dislocations
• sciatic nerve injury
• AVN

Question 9

Hip fracture

• findings
• presentation
• investigation
• management

Answer 9

Obvious asymmetry between left and right - disrupted SL
Disrupted cortical outline, bony texture
Soft tissue swelling

Severe pain, NWB
Short, ext rotated, bruising, swelling

FBC, coagulation (G&S, INR) - possible surgery
CT, MRI
Bone scan - suspecting OP

Analgesia
Arthroplasty - hemi/THR depending on medical fitness

AVN
Nonunion
Dislocation