Hip Arthritis Examination
A Hip Arthritis Examination is to assess gait and its relationship to the lumbar spine and lower limb. Therefore the patient is examined walking , standing and lying on the couch.
Forward Spinal tilt (lordosis) and pelvic obliquity may be apparent with an associated Trendelenburg waddle. There may be an apparent difference in limb length.
When lying down, restricted hip movement is most accurately diagnosed with the patient’s hip flexed at 90° in internal rotation. This is a corkscrew effect tightening the hip joint.
Other restricted movements are less sensitive. Obvious muscle wasting affecting the gluteal and quadriceps muscle is identified . Iliotibial band sensitivity is noted.
Hip arthritis : Radiological diagnosis
Pelvic x-rays are essential in the initial evaluation. They should optimally include weight- bearing and lateral views. In the early stages of Avascular necrosis, X-rays may appear unremarkable.
MRI imaging can be particularly helpful at identifying reactive changes such as bone marrow oedema, reactive geodes and hip synovitis. It should be undertaken after x-rays have been reviewed. Contrast injection of Gadolinium ( hip arthrogram) may be given to enhance soft tissue definition such as an outer labral tear.
Bone scan/SPECT is indicated where the patient’s symptoms do not correlate with the x-rays or MRI. It may identify active arthritis in the lumbar spine or knees that may/may not have been clinically