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Which Imaging Modalities, Parameters, and Diagnostic Thresholds Best Define Hip Instability? Consensus Statements
Vincent Justus Leopold1, Kawan Rakhra2, Andrea M Spiker3
1Division of Orthopaedic Surgery, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
Clinical Orthopaedics and Related Research
|April 2, 2026
Summary
This study establishes standardized imaging criteria for hip instability diagnosis. Experts agreed on key radiographic parameters like the lateral center-edge angle (LCEA) and quantitative thresholds for improved diagnostic accuracy.
Area of Science:
- Orthopedics
- Radiology
- Medical Imaging
Background:
- Hip instability diagnosis is challenging due to varied causes and imaging practices.
- Lack of consensus on relevant imaging parameters and diagnostic thresholds hinders accurate assessment.
- A Delphi consensus study was conducted to standardize diagnostic criteria for hip instability.
Purpose of the Study:
- To identify optimal imaging modalities and protocols for hip instability.
- To determine imaging parameters most associated with clinical hip instability.
- To establish quantitative imaging thresholds for diagnosing hip instability.
Main Methods:
- A modified Delphi technique was employed, adhering to ACCORD guidelines.
- 27 statements on imaging modalities, parameters, and thresholds were developed post-scoping review.
- An international expert panel achieved consensus on 81% of statements through anonymous voting.
Main Results:
- Radiography (AP pelvis, false-profile, Dunn view), MRI, and CT are foundational imaging modalities.
- Key radiographic parameters include lateral center-edge angle (LCEA), anterior wall index (AWI), posterior wall index, and Tönnis angle.
- Consensus thresholds were established: LCEA < 20° (dysplasia), 20°-25° (concerning), AWI < 0.30, PWI < 0.8, acetabular version < 5° or > 30°.
Conclusions:
- Core imaging approaches and threshold values for hip instability evaluation were defined.
- Agreement was reached on key morphometric parameters and diagnostic thresholds.
- Further research is needed for newer soft tissue and dynamic imaging measures.
