People with no hip problems often have abnormal MRI findings

Note: I recently attended the 2012 American Academy of Orthopaedic Surgeons Annual Meeting in San Francisco, California. In the next few weeks, I will present some of the important studies presented at its Specialty Day, presented by the American Orthopaedic Society for Sports Medicine.

Hip arthroscopy has gained tremendous attention in recent years. Improvements in technology for diagnosis, availability of arthroscopic equipment and techniques to facilitate procedures arthroscopically, and media reports of famous athletes undergoing hip surgery have all likely played a role in the seemingly increased focus on hip pathology in active patients. Labral tears, articular cartilage injury, and femoroacetabular impingement are some of the more common arthroscopic surgeries of the hip today.

Hip labral tear
Labral tears of the hip are often observed on MRI scans of the hip, even in asymptomatic volunteers.

However, a new study presented at the American Orthopaedic Society for Sports Medicine’s Specialty Day in San Francisco, California emphasizes the need for surgeons to correlate MRI findings with patient symptoms before deciding to proceed with surgery. Researchers at the Steadman Philippon Research Institute in Vail, Colorado performed MRI scans of one hip on 45 asymptomatic volunteers. Three musculoskeletal radiologists read the studies, and if at least two of three radiologists diagnosed pathology on the study, it was deemed to have an abnormal finding.

The results could be considered surprising. The authors found that 73% of the volunteers had abnormal findings despite no history of pain, injury, or surgery in that hip. 69% of the volunteers were found to have labral tears by MRI. Volunteers over the age of 35 were more likely to have cartilage defects and subchondral cysts.  Tweet this statistic.

The take home point from this study, in my opinion, is that sports medicine physicians and all healthcare providers must use caution in ordering and interpreting MRI studies of the hip. Since such a high percentage of patients complaining of no hip problems at all were found to have abnormal hip MRI’s, both primary-care physicians and sports medicine surgeons should carefully consider the use of hip MRI.

Hip physical therapy
Physical therapy can often be a helpful first line of treatment for hip pain.

Physicians should probably only obtain these studies if patients present with pain or mechanical symptoms, such as catching or locking, that suggest pathology within the hip joint. He or she should also be able to recreate the patient’s symptoms by physical exam. Ordering MRI’s without a thorough history and physical exam is likely to muddy the water, so to speak.

Along the same lines, surgeons must not base treatment decisions solely on MRI results. If an MRI of a patient’s hip shows a labral tear but the history and exam don’t go along with that diagnosis, it likely is an incidental finding. Surgery in that case might not improve the patient’s symptoms.

I say all of this not to scare patients or physicians away from hip MRI studies or hip surgery. Patients with labral tears, impingement, or other problems in the hip joint that are causing pain or limiting activity often have very good results from surgical treatment. But with radiology tests readily available and patients often wanting immediate answers, physicians must use caution and base diagnosis and treatment decisions on many factors.

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