Objective: To compare the sensitivity of physical examination (internal rotation of the hip) with radiographs (using the Kellgren-Lawrence grading scale) in the diagnosis of clinically significant hip osteoarthritis.
Design: Case Series, Retrospective chart review of hip pain patients that underwent fluoroscopically guided hip steroid and anesthetic injections.
Participants: 10 patients with hip pain patients seen at an academic outpatient center over a 2 year period were analyzed.
Interventions: Fluoroscopically guided hip steroid and anesthetic injection.
Main outcome measure: Pain relief and change in VAS pain score after intra-articular hip steroid and lidocaine injection was the main outcome measure.
Results: Based on Fisher's exact test, there was no association between severity of radiographic hip arthritis and pain relief with intra-articular anesthetic/steroid injection (p=0.45). Physical examination (provocative hip internal rotation) however was associated with a significant decrease in VAS pain score after intra-articular lidocaine and corticosteroid hip injection (p=0.022).
Conclusion: Simple hip radiographs alone are not sufficient to diagnose clinically significant hip osteoarthritis. Physical examination (hip internal rotation) was found to be more accurate than simple radiographs in the diagnosis of clinically significant hip osteoarthritis. Radiographs seem to best utilized when they are an extension of the physical examination and patient history.
Keywords: Hip osteoarthritis; Kellgren-Lawrence; pain; radiographs.