Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients.
BACKGROUND
Hip arthroscopy has defined elusive causes of hip pain.


OBJECTIVE
It is postulated that the reliability of various investigative methods is inconsistent. The purpose of this study is to evaluate the diagnostic accuracy of these methods.


METHODS
Retrospective review of prospectively collected data.


METHODS
Five parameters were assessed in 40 patients: clinical assessment, high-resolution magnetic resonance imaging, magnetic resonance imaging with gadolinium arthrography, intra-articular bupivacaine injection, and arthroscopy. Using arthroscopy as the definitive diagnosis, the other parameters were evaluated for reliability.


RESULTS
Hip abnormality was clinically suspected in all cases with 98% accuracy (1 false positive). However, the nature of the abnormality was identified in only 13 cases with 92% accuracy. Magnetic resonance imaging variously demonstrated direct or indirect evidence of abnormality but overall demonstrated a 42% false-negative and a 10% false-positive interpretation. Magnetic resonance arthrography demonstrated an 8% false-negative and 20% false-positive interpretation. Response to the intra-articular injection of anesthetic was 90% accurate (3 false-negative and 1 false-positive responses) for detecting the presence of intra-articular abnormality.


CONCLUSIONS
In this series, clinical assessment accurately determined the existence of intra-articular abnormality but was poor at defining its nature. Magnetic resonance arthrography was much more sensitive than magnetic resonance imaging at detecting various lesions but had twice as many false-positive interpretations. Response to an intra-articular injection of anesthetic was a 90% reliable indicator of intra-articular abnormality.
Byrd
J W Thomas
JW
Nashville Sports Medicine & Orthopaedic Center, Nashville, Tennessee 37203, USA. info@nsmoc.com <info@nsmoc.com>
Jones
Kay S
KS
D001175:Arthrography / Q000379:methods*; D001182:Arthroscopy; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D006621:Hip Joint / Q000473:pathology*; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000209:etiology; D010808:Physical Examination; D012189:Retrospective Studies; D012680:Sensitivity and Specificity