Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging.
Patients with groin, hip and pelvic pain but normal findings on MRI and minimal changes on x-ray can be a diagnostic problem. This paper looks at the arthroscopic findings of patients who have had hip pain and a positive response to an intra-articular anaesthetic but have non-contributory imaging. We hypothesized that standard MRI's were missing significant pathology and if there was a response to intra-articular local anaesthesia, pathology found during arthroscopy was likely.



A retrospective review of all hip arthroscopies performed from March 2011 to January 2015 by two orthopaedic surgeons specializing in hip arthroscopy was conducted to identify patients with clinically suspected intra-articular hip pathology despite a normal MRI report and X-ray. Clinical suspicion of intra-articular hip pathology was confirmed with a positive response to a fluoroscopically guided intra-articular injection of local anaesthetic and corticosteroid. Pathologic findings were collated from the standardised operative notes.



Fifty-three hip arthroscopies performed in 51 patients met the inclusion criteria from a total of 1348 hip arthroscopies performed over a 46-month period. All but one of the 53 (98%) hips had arthroscopically confirmed pathology. Mean patient age was 32.5 years [15 to 67 years] with 40 (78%) females and 11 (22%) males. 92.5% of the hips (49/53) were FADIR (flexion, adduction and internal rotation) positive on clinical examination, giving this test a positive predictive value of 98% (95% CI: 89.31 to 99.67%) for intra-articular pathology.



In patients with a normal MRI without contrast and a positive response (relief of pain) to an intra-articular injection that failed conservative management, there is a 98% chance of intra-articular hip pathology being discovered on hip arthroscopy.
Austin Health, Austin Hospital, PO Box 5555, Heidelberg, VIC, 3084, Australia. joelbuikstra@gmail.com.
Joel Glenn
JG
Buikstra
Orthopaedic Surgery, Western Health, Footscray, VIC, Australia.
Camdon
C
Fary
Orthopaedic Surgery, Western Health, Footscray, VIC, Australia.
Phong
P
Tran
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D018771:Arthralgia / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017699:Pelvic Pain / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local
Hip arthroscopy; Image-guided injection; Intra-articular hip pathology; Magnetic resonance imaging