Analyzing hip X-ray

[HenryH]

Would it be okay if I posted an x-ray image of the hips of an anonymous patient who has been diagnosed with mild hip dysplasia? It is not an x-ray of my own hips. The reason I would like to post the x-ray is because an attending physician (orthopedic surgeon) examined it and could, at best, come to the conclusion that the patient "may or may not" develop arthritis at some point in their life. For educational purposes and out of sheer curiosity, I would be interested in hearing some of you guys' predictions on how likely it is that this patient will develop hip arthritis in the future.

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[samsoniter]

yes as long as it is anonymous

 

[HenryH]

Thanks. So to re-iterate, the patient has been diagnosed with very mild hip dysplasia in the right hip. This particular patient is a male aged 24 or 25 who runs a high-moderate number of miles (I think 7 or 8) every day. How likely do you think this patient is to develop arthritis in their right hip in the future? If they're likely to develop the condition, when do you think it will develop (e.g., their 40s, 50s, etc.)? Here's the x-ray:

Thanks...

 

[cbtk18]

.

 

[HenryH]

I don't see anything

Do you mean you don't see anything wrong with the hip, or you don't see the image at all? If the image isn't showing up, here's a direct link:

http://i46.tinypic.com/907kfr.jpg

 

[Buckeye(OH)]

I think you could make an argument (though I didn't measure) for very, very, very mild joint space narrowing compared to the contralateral side. Perhaps a touch of sclerosis as well. I would be hard pressed to call this DDH though again, i didn't measure an acetabular index. I would say he's good for a long, long while. If you look at the amount of head that is uncovered, its almost the same so you could say either both hips have mild DDH or, more likely, they are both normal.

 

[HenryH]

I think you could make an argument (though I didn't measure) for very, very, very mild joint space narrowing compared to the contralateral side. Perhaps a touch of sclerosis as well. I would be hard pressed to call this DDH though again, i didn't measure an acetabular index. I would say he's good for a long, long while. If you look at the amount of head that is uncovered, its almost the same so you could say either both hips have mild DDH or, more likely, they are both normal.

Thanks for your input. Just out of curiosity, would you say that high-impact activities such as running are contraindicated for this patient? When the patient's right hip does start to undergo joint space narrowing, do you think injections of a a viscosupplement such as Supartz could inhibit further cartilage degradation?

 

[toehammer]

i see acetabular retroversion and a crossover sign

 

[HenryH]

i see acetabular retroversion and a crossover sign

Interesting... as far as I know, the patient wasn't diagnosed with FAI and didn't express experiencing the usual symptoms of FAI. How do you see the acetabular retroversion and crossover sign? Do you think the patient will start exhibiting signs of hip OA in the next decade or so?

 

[rigid]

How much longer do we pretend that you or someone you know isn't the patient?

 

[skiz knot]

Interesting... as far as I know, the patient wasn't diagnosed with FAI and didn't express experiencing the usual symptoms of FAI. How do you see the acetabular retroversion and crossover sign? Do you think the patient will start exhibiting signs of hip OA in the next decade or so?

This patient will definitely get OA in the future. Based on the xrays they will become symptomatic from the OA to the point of re-seeking medical care in 96-104 months. They will have a total hip arthroplasty that, unfortunately, will be complicated by infection. They will have a chronically painful hip after surgery and diagnosis of infection will be delayed 22-24 months until follow-up radiographs show extensive osteolysis and acetabular bone loss. They will have the implants removed and an antibiotic cement spacer placed. Unfortunately, they will sustain both a perioperative DVT and MI. They eventually go into CHF after the MI and PE and are no longer considered an acceptable risk for surgery. They will then have to live the rest of their short life with a painful, functionless hip until their untimely death, in the year 2028. Sorry for the bad news. Hate to break it to you. You should be careful when you show xrays to orthopaedic surgeons, they are able to predict the future based on what the xrays show.

 

[skiz knot]

Interesting... as far as I know, the patient wasn't diagnosed with FAI and didn't express experiencing the usual symptoms of FAI. How do you see the acetabular retroversion and crossover sign? Do you think the patient will start exhibiting signs of hip OA in the next decade or so?

This patient will definitely get OA in the future. Based on the xrays they will become symptomatic from the OA to the point of re-seeking medical care in 96-104 months. They will have a total hip arthroplasty that, unfortunately, will be complicated by infection. They will have a chronically painful hip after surgery and diagnosis of infection will be delayed 22-24 months until follow-up radiographs show extensive osteolysis and acetabular bone loss. They will have the implants removed and an antibiotic cement spacer placed. Unfortunately, they will sustain both a perioperative DVT and MI. They eventually go into CHF after the MI and PE and are no longer considered an acceptable risk for surgery. They will then have to live the rest of their short life with a painful, functionless hip until their untimely death, in the year 2028. Sorry for the bad news. Hate to break it to you. You should be careful when you show xrays to orthopaedic surgeons, they are able to predict the future based on what the xrays show.

 

[KLPM]

This patient will definitely get OA in the future. Based on the xrays they will become symptomatic from the OA to the point of re-seeking medical care in 96-104 months. They will have a total hip arthroplasty that, unfortunately, will be complicated by infection. They will have a chronically painful hip after surgery and diagnosis of infection will be delayed 22-24 months until follow-up radiographs show extensive osteolysis and acetabular bone loss. They will have the implants removed and an antibiotic cement spacer placed. Unfortunately, they will sustain both a perioperative DVT and MI. They eventually go into CHF after the MI and PE and are no longer considered an acceptable risk for surgery. They will then have to live the rest of their short life with a painful, functionless hip until their untimely death, in the year 2028. Sorry for the bad news. Hate to break it to you. You should be careful when you show xrays to orthopaedic surgeons, they are able to predict the future based on what the xrays show.

You missed the part where they invest poorly and lose all their money.

edit: I think the patient has swallowed a person! I swear I can see the shadow of a human being in the pelvis.

 

[skiz knot]

You missed the part where they invest poorly and lose all their money.

I thought that was already obvious. I mean, c'mon...

 

[KLPM]

I thought that was already obvious. I mean, c'mon...