X-rays May Miss Hip Arthritis

X-rays don’t detect hip arthritis in many patients, resulting in delayed diagnosis and treatment, researchers report.

The researchers looked at information from almost 4,500 Americans taking part in two arthritis studies. In one study, only 16% of the patients with hip pain had X-ray evidence of osteoarthritis in the hip and only 21% of those with X-ray evidence of arthritis had hip pain.

“The majority of older subjects with high suspicion for clinical hip osteoarthritis did not have radiographic hip osteoarthritis, suggesting that many older persons with hip osteoarthritis might be missed if diagnosticians relied on hip radiographs to determine if hip pain was due to osteoarthritis,” said study corresponding author Dr. Chan Kim.

Kim is an instructor of medicine at Boston University School of Medicine.

A missed or delayed diagnosis of hip arthritis can have serious consequences. Up to 10% of patients with hip arthritis don’t get enough exercise and are at increased risk for heart and lung disease, obesity, diabetes and falls, the researchers said.

“Given these findings, patients with suspected hip OA [osteoarthritis] should be treated regardless of X-ray confirmation,” Kim said in a university new release.



Hip arthritis is a major health issue that causes pain and disability. Each year, more than 333,000 hip replacements are performed in the United States, according to the researchers.

My Take:
I chose to review this study because I have never seen good correlation between the amount of bone damage seen on X-ray of the hip and the degree of pain felt by the patient. As the study notes, I have had many patients with severe hip pain that showed little or no osteoarthritis on X-ray. I have also seen patients who’s hip are totally degenerated, and are pain free.

Many years ago hip joint replacement was reserved for elderly patients. The thinking was the artificial joint might last 10-15 years and repeat hip replacements don’t often go well. A patient in their 40s or 50s might face three or more hip replacements in a lifetime. So I had a number of middle aged patients with significant hip joint degeneration. My job was to reduce the pain and stabilize the hip until they were old enough to undergo the surgery. This was surprisingly easy to accomplish.

Today, hip joint replacement is performed routinely on much younger patients. The rationale is that the prosthetic devices last a little longer and they want to operate before the patient becomes too deconditioned from adopting a sedentary lifestyle. Now a patient in their 40s or 50s is getting that artificial hip.

Of course, I think they have it backwards – It is the sedentary lifestyle that leads to the osteoarthritis in most cases. Sure, you might have damaged that hip playing high school football but if you had stayed active, the circulation to the hip would remain intact and the degeneration would be minimal.

The Bottom Line:
Although I agree with the findings of this study, I’m afraid its intent is to further justify hip joint replacement on an ever younger population. Physical therapy, nutritional supplementation, and chiropractic manipulation are the best tools to rehabilitate a hip joint. An active lifestyle is the way to prevent the issue in the first place.

Source: December 10, 2015 National Institutes of Health