Radiological workup of the hip includes at least an antero-posterior (AP) radiograph of the pelvis and a lateral radiograph of the hip. All these classification systems and threshold values are open for discussion, but they rely on good clinical practice standards for which preservative hip surgery should not be performed after 50 years of age or when the radiological JSW is < 2 mm. Rapidly destructive hip OA is uncommon and is defined by the development of complete loss of radiological JSW or severe bone attrition on CR within 12 months after symptoms onset (Fig.

The clinical course of hip OA is usually slow and pain fluctuates over the years with no or minor radiological changes over time (Fig. Early-stage and late-stage OA differ according to the absence or presence of radiological structural changes with a joint space width (JSW) of more or less than 2 mm on AP pelvic radiographs (Fig. Early-onset and late-onset disease develop either before or after 50 years of age. In secondary hip OA, joint degradation results from preexisting conditions including developmental hip dysplasia, growth-associated disorders, fracture, femoral head osteonecrosis and inflammatory or metabolic synovial disorders (Fig. In primary hip OA, cartilage degradation can either be idiopathic or develop in association with dynamic conflict between the articular surfaces, the FAI syndrome (Fig. Hip OA can be classified according to its etiology, time of onset, severity, and clinical course. Imaging of femoro-acetabular impingement (FAI) and advanced quantitative MR techniques for the cartilage are out of the scope of this article and will be addressed separately in this Skeletal Radiology issue. This review article also highlights the importance of rigorous acquisition and reading of hip radiographic and MR images. The current special issue of Skeletal Radiology granted us the opportunity to address a fundamental question: is radiography still needed to diagnose hip OA? Which imaging modality should be used to diagnose stage and quantify hip OA in clinical practice, in clinical trials and in research? After a brief review on classifications and diagnostic criteria, the current narrative article will summarize strengths and weaknesses of CR and MRI to diagnose hip OA and will propose perspectives on the use of medical imaging. Over the years, magnetic resonance imaging (MRI) emerged as a powerful imaging modality to detect cartilage lesions and structural changes of the hip joint. For decades, conventional radiography (CR) has been used to support the clinical diagnosis of hip OA. In patients with clinically suspected hip OA, medical imaging contributes to confirm the diagnosis and rule out alternative diagnoses by demonstrating cartilage lesions and associated structural changes. Hip osteoarthritis (OA) is a highly prevalent and disabling disorder that affects elderly but also young patients with a high socio-economic burden. The absence of a validated MR biomarker of early OA, together with issues related to machine availability and MRI protocol repeatability, prevent the widespread use of MRI in clinical trials. MRI seems to be more suitable than radiographs as a biomarker for clinical trials addressing early OA. However, structural joint changes are frequent in asymptomatic population and neither radiographs nor MRI have shown a good correlation with pain and functional impairment. Magnetic resonance imaging (MRI) is more sensitive to detect joint effusion/synovitis, cartilage, labral, and bone marrow lesions. The choice of the appropriate lateral view depends on the clinical indication, Lequesne’s false profile being valuable in the assessment of OA. They should be obtained in a rigorous technique that includes an antero-posterior (AP) radiograph of the pelvis. Conventional radiographs are recommended as the first line imaging modality to investigate chronic hip pain. Diagnosis of hip osteoarthritis (OA) is based on clinical arguments, and medical imaging is obtained to confirm the diagnosis and rule out other possible sources of pain.

Normal male hip xray