Major pelvic joint surgery isn’t always hip

Early diagnosis of femoro-acetabular impingement syndrome could prevent degenerative arthritis of the hip. It may keep young patients from potentially expensive, and possibly disastrous, invasive treatment interventions, according to research presented at the RSNA meeting.

Total joint replacement has become a popular treatment for ailing hips in elderly patients. Femoro-acetabular lesions affect mostly younger patients, however. The anatomic changes involved in femoro-acetabular impingement syndrome can be identified on conventional radiography, MRI, and CT. Unfortunately, these radiographic findings go mostly unrecognized and could have dire consequences, said Dr. Douglas P. Beall, chief of musculoskeletal ultrasound at the University of Oklahoma.

Beall chaired an Integrated Science and Practice session on musculoskeletal imaging at the meeting that introduced several strategies for timely diagnosis of the condition.

Keynote speaker Dr. Suzanne Anderson, a musculoskeletal radiologist at the University Hospital of Berne in Switzerland, offered the audience a glimpse of the radial-reformation MRI technique used at her institution. MR-based radial imaging could help radiologists confirm or exclude diagnosis of femoro-acetabular impingment syndrome, stage the condition, and provide appropriate treatment direction, Anderson said.

Dr. Takashi Nishii and colleagues at the University of Osaka in Japan proposed an alternative imaging technique to diagnose acetabular labrum and articular cartilage defects in hip dysplasia. The investigators assessed 36 hip joints in 26 patients using multislice CT-based radial reconstruction arthrography. They found the procedure, based on sequential reconstructions of the acetabular circumference at 30° angles, provided accurate diagnosis of labral and cartilage disorders.

"Acetabular labral disorders play an important role on articular cartilage disease and osteoarthritis progression in hip dysplasia," Nishii said.

A different study by Dr. Kenjirou Ohashi and colleagues at the University of Iowa presented results that could sustain concerns about misdiagnosis.

The team reviewed more than 100 x-rays of acetabular fractures over 38 months and compared the diagnostic performance of orthopedic trauma surgeons and musculoskeletal radiologists. They found that experienced orthopedic trauma surgeons are only moderately reliable and not necessarily better than radiologists when classifying these lesions based on radiography.

For more online information, visit Diagnostic Imaging's RSNA Webcast.