Radiographic Evaluation of Hip

Dr Pankaj Narekar, MD.DCA Imaging.

Pelvis • Soft tissue• Bones

▫ Iliopectineal line▫ Ilioischial line▫ Shenton’s line

Acetabular cavity• Depth• Inclination• Version

Femoral Head • Sphericity• Position of Hip centre• Head –Neck offset• Congruency

Head neck junction & offset

Position femoral head epiphysis – DDH & SCFE

Hip Pain

Pediatric1. Perthes disease2. DDH3. SCFE4. Congenital coxa Vara5. Trauma6. Neoplastic

Adult1. FAI2. AVN3. Inflammatory Arthritis4. OA5. Transient osteoporosis/

Subchondral insufficiency fracture

6. Trauma7. Neoplastic

Pincer Impingement Cam Impingement

• Focal or general overcoverag Aspherical head

• 40 (40-57) 32 (21-51)• Coxa profunda Pistol-grip deformity

• Protrusio acetabuli CCD angle < 125°• Focal acetabular retroversion offset ratio-0.18 (figure-8 configuration)• Lateral center edge angle > 39° Alpha angle > 50°• Posterior wall sign • Ischial spine sign

• radiology.rsna.org/content/264/3/651.abstract

Subchondral insufficiency fracture/ Transient Osteoporosis

• M > F

• Elderly patient,3rd trimester of pregnancy. Focal reduced bone density. Subchondral lucent line. Flattening Step off.

Avascular necrosis

• Increased bone density• Flattening/ depression• Deformity

Infection

• Idiopathic avscular necrosis of hip• 2- 14 yrs• M>F

• Small capital epiphysis• Sclerosis• Flattening/depression• Fragmentation• Healing

Perthe’s Disease

Evaluation for DDH

SCFE

Take home points

• Pelvic Bone▫ Iliopectineal line▫ Ilioischial line▫ Shenton’s line

•Femoral Head ▫ Sphericity▫ Position of Hip centre▫ Head –Neck offset▫ Congruency

THANK YOU