Purpose
The purpose of this study was to document and compare the incidence of intra-articular
hip pathologic findings identified using arthroscopy versus conventional imaging in
patients with acute trauma to the hip.
Methods
This was a blinded prospective case series study designed to review the incidence
of intra-articular pathologic disorders in patients with post-traumatic injury between
the ages of 18 and 65 years who were referred to a single surgeon. Injuries included
hip dislocation, proximal femur fracture, pelvic ring fracture, acetabular fracture,
penetrating injury (gunshot wound), and soft tissue injury. Preoperative radiographs,
computed tomographic (CT) scans, or magnetic resonance imaging/magnetic resonance
angiography (MRI/MRA) scans (or a combination of these) were obtained. Findings were
documented and compared with intraoperative findings.
Results
A total of 29 post-traumatic hips were enrolled in this study. Hip arthroscopy identified
17 of 29 hips (59%) as having loose bodies, 11 of 29 (38%) hips as having an intra-articular
step deformity, 14 of 29 (49%) hips as having an osteochondral lesion, and 27 of 29
(93%) hips as having a labral tear. Plain radiographs and CT scans yielded low sensitivity
when compared with arthroscopy for the identification of loose bodies and step deformities.
MRI/MRA comparison with arthroscopic findings suggest that MRI/MRA is an accurate
tool for identification of labral tears, because 91% of tears seen on arthroscopy
were also identified by MRI/MRA. In 4 hips, however, MRI/MRA failed to identify osteochondral
lesions that were subsequently identified by arthroscopy.
Conclusions
Traumatic injuries of the hip result in substantial intra-articular pathologic findings,
including loose bodies, labral tears, step deformities, and osteochondral lesions.
The arthroscope is a powerful tool in identifying these injuries. Plain radiographs
and CT scans appear to underestimate the true incidence of loose bodies and step deformities
within the joint when compared with hip arthroscopy after a traumatic injury of the
hip.
Level of Evidence
Level IV, diagnostic case series.
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Article info
Publication history
Accepted:
November 26,
2013
Received:
April 3,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding in relation to this article: I.H.W. receives support from Smith & Nephew.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
