Imaging of hip disorders

Many different imaging modalities are available to assist in the evaluation of hip disease. One must choose the image or series of images that not only provide the most diagnostic and clinical information, but also remain the simplest and most cost effective for the patient. The initial examination should be the conventional radiograph. This will provide, in most instances, the most diagnostic information for arthritic disease, stress and insufficiency fractures, infection, and bone tumors. If the conventional radiograph is normal, or if more information is needed, bone scintigraphy should be done next. Bone scintigraphy will confirm the presence of disease, demonstrate its anatomic location, and give some information as to its physiologic state. Computed tomography does not play an important role in the evaluation of hip disease except in acute fractures involving the acetabulum. MR imaging is the modality of choice for diagnosing and staging osteonecrosis, searching for marrow disease, assessing cartilage abnormality, and evaluating the extent of soft-tissue disease.