Clinical Evaluation of the Hip: Radiologic Evaluation

For the patient with a painful hip, radiographic analysis is essential for the complete work up. For those patients with relatively normal-appearing radiographs, careful analysis for the loss of femoral head-neck offset and subtle acetabular dysplasia (ie, retroversion) may provide a clue to the presence of intra-articular abnormality. Periacetabular ossicles and synovial herniation pits often considered normal variants should be considered markers for impingement or labral pathology. A generalized magnetic resonance of the entire pelvis is insufficient for evaluating internal derangements of the hips but may be needed to evaluate nonfocal pain. For those with clinical suspicions of labral pathology, direct magnetic resonance arthrography of the affected hip continues to yield the highest sensitivity, accuracy, and reproducibility for detection of labral tears. It is important to evaluate, not only the labrum, but cartilage, joint capsule, ligamentum teres, and surrounding muscles and tendons to confirm clinical suspicions, provide preoperative planning, and offer prognostic information.