Hip osteoarthritis 'often missed by x-ray scans'

Hip x-rays may not be a reliable means of diagnosing hip osteoarthritis in the majority of cases, according to a new study.

Conducted by the Boston University Medical Center in the US and published in the British Medical Journal, the research aimed to evaluate the diagnostic performance of x-ray scans in patients with clinical signs and symptoms of osteoarthritis, reaching the conclusion that the method may actually delay the treatment of the disease.

Researchers assessed data from the Framingham Osteoarthritis and Osteoarthritis Initiative studies, which included nearly 4,500 participants. In the Framingham study, it was shown that only 16 per cent of the patients with hip pain had osteoarthritis that was detectable through radiographic scans, while only 21 per cent of hips with radiographic osteoarthritis were affected by hip pain.

Results of the Osteoarthritis Initiative were similarly low at nine per cent and 24 per cent, respectively. As such, it was noted that in both study populations, hip pain was not present in many patients with radiographic osteoarthritis, and many with hip pain did not show any radiographic evidence of hip osteoarthritis.

It suggests that many cases of hip osteoarthritis might be missed if clinicians rely on x-ray scans alone, putting these patients at risk of being physically inactive, suffering injury through falls, or developing heart and lung disease, diabetes or obesity.

Dr Chan Kim, instructor of medicine at Boston University School of Medicine, said: "Given these findings, patients with suspected hip osteoarthritis should be treated regardless of x-ray confirmation."

Dr Katherine Free, research liaison and communications manager for Arthritis Research UK, said: "Hip pain can occur for a variety of reasons. In many cases, it could be due to a simple strain, but for some people it may be a sign of osteoarthritis. Hip osteoarthritis is a painful and debilitating condition which usually affects people from the late 40s onwards; this study highlights the need for new and improved ways to diagnose this condition.

"Arthritis Research UK is funding research into the cure, prevention and treatment of all forms of arthritis, including research at the University of Bristol that aims to identify genetic risk factors for hip osteoarthritis. The results of this work may in the future help doctors predict which patients are likely to be at risk of developing this condition, and contribute to earlier diagnosis."

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