Study: Clinical correlation critical on pre-surgical hip MRI

MRI should not replace clinical observation in the treatment of patients with hip pain, as 73 percent of healthy volunteers had abnormal findings on MRI, according to a study presented Feb. 11 at American Orthopaedic Society for Sports Medicine's Specialty Day in San Francisco.

Previous studies had shown a high prevalence of hip pathology in athletes with groin pain, however, the prevalence of abnormal MRI findings in an asymptomatic population was unknown, according to the research team led by Bradley C. Register, MD, of the Steadman-Philippon Research Institute in Athens, Ga.

Register and colleagues designed a study to assess a cohort of asymptomatic individuals to determine the prevalence of hip pathology.

The researchers evaluated 45 volunteer subjects with no history of hip pain, symptoms, injury or previous surgeries. Each participant underwent an MRI scan which was reviewed by three separate radiologists. These scans were mixed with 19 studies from symptomatic patients to blind the reviewers to the possibility of patient symptoms.

Scans identified labral tears as the most common of the abnormalities displayed, making up nearly 69 percent of the joint conditions. Given the high incidence of asymptomatic labral tears, it is important to determine whether a tear is symptomatic or asymptomatic, Register told Health Imaging. “Prior to operating on a patient with a labral tear, [physicians] should rule out other potential causes of pain and ensure that the clinical findings are consistent with a labral tear,” he said.

Volunteers older than 35 years of age were more prone to abnormalities, with a 13.7 times greater likelihood of having chondral defects and a 16.7 times greater chance of having a subchondral cyst. The researchers noted a strong correlation seen between patient age and early markers of cartilage degeneration such as cartilage defects and subchondral cysts.

“The hope with a study like this is improved treatment and decision-making for physicians who are dealing with hip disorders,” Register said in a statement. “Our results emphasize the importance of correlating clinical signs and symptoms with imaging findings when considering surgery for patients with these conditions.”

Radiologists can assist in these by looking for findings such as cam lesions and acetabular edema, Register added.