Imaging in Hip Disorders

When investigating someone with a hip disorder, Dr Balakumar aims to ascertain where the pathology is originating from. After thorough history and examination, Dr Balakumar will then utilize imaging to confirm his diagnosis.

Especially if your clinician is considering surgery, then he or she should have convincing imaging suggestive of the pathology. The imaging usually tells the “truth” however it can often be misread or misinterpreted by clinicians. Dr Balakumar would often order a 4 plain X-rays. A standing X-ray pelvis(AP-frontal plane), A standing faux profile (side view of the socket), a Von Rosen view (for hip dysplasia) and a frog lateral view (a side view of the head).

• AP Standing AP Standing
• Faux Profile Faux Profile
• Von Rosen Von Rosen
• Frog lateral Frog lateral
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Following this he may supplement this with a CT scan which better delineates and reconstructs bony imaging. Both CT scans and X-rays involves the use of a X-ray beam. The dosage of radiation is similar to a plane trip to Sydney with single X-ray and up to 20x more radiation for CT scans of the hip and pelvis. In itself it is not significant but in repeated doses can be harmful.

Finally Dr Balakumar will often supplement his investigations with cartilage mapping sequences. This is usually designed to give quantitative analysis of the cartilage in the hip to see if the patient is a suitable candidate for joint preservation options. This can be particularly useful when investigating hip dysplasia in the adolescent or adult, where one cannot decide whether joint preservation or joint replacement is the reasonable option. The dGEMRIC (a specialised cartilage mapping sequence) can help not only Dr Balakumar but also the patient.

Dr Balakumar together with radiologists at the Royal Children’s Hospital and Melbourne Radiology Clinic are using this cutting edge technology for this specific patient population. An example of this is below.

This logarithmic curve can give Dr Balakumar and the patient a prognostic % to the chances of success from the joint preservation options such as periacetabular osteotomy. Most of this work was pioneered in the United States and Switzerland and has recently been bought over to Melbourne.

For clinicians interested in this area, below is the link to the article than can be viewed for a evidence based approach to cartilage mapping. The images used in this document have been borrowed from this article.

References:

• Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia. J Bone Joint Surg Am. 2006 Jul;88(7):1540-8