Osteoarthritis of the hip: is radiography still needed?

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. Conventional radiographs are recommended as the first line imaging modality to investigate chronic hip pain. They should be obtained in a rigorous technique that includes an antero-posterior (AP) radiograph of the pelvis. The choice of the appropriate lateral view depends on the clinical indication, Lequesne's false profile being valuable in the assessment of OA. Magnetic resonance imaging (MRI) is more sensitive to detect joint effusion/synovitis, cartilage, labral, and bone marrow lesions. However, structural joint changes are frequent in asymptomatic population and neither radiographs nor MRI have shown a good correlation with pain and functional impairment. MRI seems to be more suitable than radiographs as a biomarker for clinical trials addressing early OA. 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.

Automated summary

Diagnosis of hip osteoarthritis (OA) relies on clinical arguments, and medical imaging is used to confirm the diagnosis and exclude other sources of pain. X-rays are recommended as the first line imaging modality for investigating chronic hip pain, while MRI is more sensitive in detecting joint fluid/synovitis, cartilage, labral, and bone marrow lesions. However, neither X-rays nor MRI show a good correlation with pain and functional impairment. MRI may be more suitable as a biomarker for clinical trials on early OA, but issues with validation, machine availability, and protocol repeatability limit its widespread use.