Hip Osteoarthritis Diagnosis

Hip Differential Diagnosis

Osteoarthritis (OA)

• Definition: A degenerative joint disease characterized by wear and tear of the articular cartilage, leading to bone-on-bone contact and joint pain.
• Clinical Features:
  • Gradual onset of hip pain, stiffness, and limited mobility
  • Pain worsens with activity and improves with rest
  • Crepitus (grating or cracking sensation) may be present
• Imaging Findings:
  • Radiographs: Joint space narrowing, osteophytes, and subchondral sclerosis
  • MRI: Cartilage thinning, bone marrow edema, and cysts

Femoroacetabular Impingement (FAI)

• Definition: A condition where the femoral head and acetabulum do not fit together properly, causing abnormal contact and damage to the joint.
• Types:
  • Cam-type: Abnormal shape of the femoral head
  • Pincer-type: Abnormal shape of the acetabulum
  • Mixed-type: Combination of both
• Clinical Features:
  • Hip or groin pain, especially with flexion and internal rotation
  • Limited range of motion and stiffness
  • Positive impingement test ( reproducing pain with manual compression)
• Imaging Findings:
  • Radiographs: Abnormal shape of the femoral head or acetabulum
  • MRI: Labral tears, cartilage damage, and bone marrow edema

Labral Tears

• Definition: A tear in the fibrocartilaginous labrum that surrounds the acetabulum.
• Causes:
  • Trauma (e.g., falls, sports injuries)
  • FAI
  • Degenerative changes (e.g., OA)
• Clinical Features:
  • Hip or groin pain, especially with flexion and internal rotation
  • Clicking or catching sensations
  • Limited range of motion and stiffness
• Imaging Findings:
  • MRI: Labral tear or degeneration
  • MR arthrogram: Contrast material leakage into the joint space

Bursitis

• Definition: Inflammation of the fluid-filled sacs (bursae) that reduce friction between moving parts in the hip joint.
• Types:
  • Trochanteric bursitis: Inflammation of the bursae at the greater trochanter
  • Iliopsoas bursitis: Inflammation of the bursae at the iliopsoas tendon
• Clinical Features:
  • Lateral hip pain, swelling, and tenderness
  • Pain worsens with activity and improves with rest
  • Positive tenderness test (reproducing pain with palpation)
• Imaging Findings:
  • Ultrasound: Fluid accumulation and inflammation in the bursae
  • MRI: Inflammation and fluid accumulation in the bursae

Hip Differential Diagnosis

Osteoarthritis (OA)

• Characterized by wear and tear of articular cartilage, leading to bone-on-bone contact and joint pain
• Gradual onset of hip pain, stiffness, and limited mobility
• Pain worsens with activity and improves with rest
• Crepitus may be present
• Imaging findings: joint space narrowing, osteophytes, and subchondral sclerosis on radiographs; cartilage thinning, bone marrow edema, and cysts on MRI

Femoroacetabular Impingement (FAI)

• Condition where the femoral head and acetabulum do not fit together properly, causing abnormal contact and damage to the joint
• Types: cam-type, pincer-type, and mixed-type
• Cam-type: abnormal shape of the femoral head
• Pincer-type: abnormal shape of the acetabulum
• Mixed-type: combination of both
• Hip or groin pain, especially with flexion and internal rotation
• Limited range of motion and stiffness
• Positive impingement test
• Imaging findings: abnormal shape of the femoral head or acetabulum on radiographs; labral tears, cartilage damage, and bone marrow edema on MRI

Labral Tears

• Tear in the fibrocartilaginous labrum that surrounds the acetabulum
• Causes: trauma, FAI, and degenerative changes
• Hip or groin pain, especially with flexion and internal rotation
• Clicking or catching sensations
• Limited range of motion and stiffness
• Imaging findings: labral tear or degeneration on MRI; contrast material leakage into the joint space on MR arthrogram

Bursitis

• Inflammation of the fluid-filled sacs (bursae) that reduce friction between moving parts in the hip joint
• Types: trochanteric bursitis and iliopsoas bursitis
• Trochanteric bursitis: inflammation of the bursae at the greater trochanter
• Iliopsoas bursitis: inflammation of the bursae at the iliopsoas tendon
• Lateral hip pain, swelling, and tenderness
• Pain worsens with activity and improves with rest
• Positive tenderness test
• Imaging findings: fluid accumulation and inflammation in the bursae on ultrasound and MRI