[Coxarthrosis].
Osteoarthritis of the hip joint is a very common disease. There is a minor prevalence of males. By etiology one can distinguish primary (idiopathic) from secondary osteoarthritis. Secondary are due to well-known etiologies as overweight, repetitive traumata, malposture, muscle- and tendon-imbalance etc. Osteoarthritis includes not only cartilage abnormalities, but also such of the subchondral-region, synovialis, synovial fluid and periarticular muscles. The cartilage shows in osteoarthritis typically edema and swelling, defects with tears, fibrillation, and "baldness" and (or) cartilagenous repair-islands and joint space narrowing as well, while subchondrally micro-edema, necrosis, ev. microfractures, "cysts", demineralisation followed by sclerosis, osteophyte-formation and deformity is seen. With conventional radiographs and CT joint space narrowing, subchondral cysts, sclerosis and osteophytes and deformities are well delineated, MRI however allows visualization of subtle bone marrow and cartilage abnormalities. Clinically, the diagnosis of pre-osteoarthritis becomes more and more important. This includes e.g. deformities and malpostures, labrum-pathologies and structural imbalances. There are three prognostic different types of hip-osteoarthritis depending on the migration of the head of the hip joint: the most common are the latero-cranial and the medio-caudal ones, while the central one is found very rarely. Basic imaging method are conventional radiographs, and CT, followed by MRI. The diagnosis of an "activated osteoarthritis" is made by bone-scintigraphy or MRI with i.v. application of contrast-media. The labrum- and cartilage diagnosis should be done with MRI or MR-arthrography. Functional computer-animated analysis will be of great diagnostic value in the near future. MRI indications are differences between clinical results and imaging, missing clinical improvement of an "activated" osteoarthritis under standard therapy, unclear joint-pain and before any arthroscopy.
Imhof
H
H
Univ.-Klinikum für Radiodiagnostik-Osteologie, Waehringer Guertel 18-20, 1090 Wien/Osterreich. mr@univie.ac.at
Czerny
C
C
Gahleitner
A
A
Grampp
S
S
Kainberger
F
F
Krestan
C
C
Sulzbacher
I
I
D000368:Aged; D001175:Arthrography; D002358:Cartilage, Articular / Q000473:pathology; D005260:Female; D006621:Hip Joint / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D013583:Synovial Membrane / Q000473:pathology; D014057:Tomography, X-Ray Computed