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Radiographic Evaluation of the Impinging Hip

Radiographic Evaluation of the Hip

  • You can get a lot of information from the plain radiographs
    • fractures
    • djd (degenerative joint disease)
    • sclerosis
    • congruency
    • scanogram (limb length and alignment)
    • loose bodies
    • osteochondroma
    • osteoid osteoma
    • bony prominence @ head neck junction (Cam impingement)
    • coxa profunda
    • protrusion 
    • crossover sign
    • posterior wall sign
    • acetabular dysplasia
  • AP Pelvis
    • coccyx should centered 1-3 cm over pubic symphysis
    • symmetric obturator foramen
    • can see crossover sign, asphericity
  • Lateral of the Hip
    • frog, cross table, dunn, etc
    • frog lateral good for head neck junction (although it may be obscured by greater trochanter)
    • cross table lateral is better
      • can see articulation, AIIS, and head neck junction
      • sometimes can see arthritis that you can’t see on other views, particularly posteriorly
  • Modified Dunn Lateral
    • 45 and 90
  • False Profile
    • lateral of acetabulum
    • Lateral acetabular center edge angle
  • AP pelvis not the same as AP of the hip
  • Alpha angle
    • insurance companies usually require alpha angle greater than 50-55 degrees
    • reliability of the measurement is quite poor
    • larger alpha angles associated with greater degrees of FAI
  • Coxa profunda
    • floor of fossa acetabula touches the ilioischial line and > 35 degrees
  • Protrusio
    • head overlaps ilioischial line
      • not considered contraindication to hip arthroscopy anymore
  • Crossover sign
    • indicates cranial retroversion
  • Stork view
    • excessive motion indicative of osteitis pubis
  • CT Scan
    • look at stress fractures better
    • look at AIIS
    • definitely for revision cases or where bony anatomy is unclear
  • Anatomy
    • capsule does not insert into labrum
    • there is a cleft between labrum and capsule
  • Ultrasound
    • gluteus medius tears
    • office injections

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