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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Musculoskeletal Disorders 1/2017

Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2017
Autoren:
Joel Glenn Buikstra, Camdon Fary, Phong Tran
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-017-1485-5) contains supplementary material, which is available to authorized users.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
Zusatzmaterial
Additional file 1: Fluoroscopic injection of steroid and local anaesthetic into the hip joint. Pain diary that patients were asked to complete. (JPG 137 kb)
12891_2017_1485_MOESM1_ESM.jpg
Additional file 2: Observations of study parameters. Parameters including. gender, age, MRI report, response to injection and arthroscopic findings. (DOCX 145 kb)
12891_2017_1485_MOESM2_ESM.docx
Literatur
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