Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Diagnosis and Imaging
Diagnosing the need for a hip replacement is a process of confirming that the pain is indeed coming from the hip joint and that the damage is severe enough to warrant surgery. Hip pain can be tricky; it can mimic back problems, hernias, or knee issues. Therefore, doctors rely on a combination of a physical exam, your personal history, and imaging studies to build a complete picture.
The goal of diagnosis is not just to see the arthritis but to measure it. Surgeons need to know the shape of your bones, the quality of your bone stock, and leg length differences to plan the perfect surgery. This section explains the diagnostic journey, from the first clinic visit to the advanced scans used for robotic planning.
The Physical Examination
The exam starts with a conversation. The doctor will ask about the location of your pain (groin vs. buttock), what worsens it (walking, putting on shoes), and what improves it. They will watch you walk to see if you have a limp, which is a common sign of the body trying to protect a painful hip.
During the hands-on exam, you will lie on an exam table. The doctor will move your leg in various directions to measure your range of motion. A loss of internal rotation (turning the foot inward) is often the first sign of hip arthritis. They will also look for leg length discrepancy—arthritis can erode bone, making the affected leg shorter. They will press on areas around the hip to rule out bursitis or tendonitis.
X-Rays: The Gold Standard
The simple X-ray is the most important tool for diagnosing hip arthritis. It provides a clear view of the bones. In a healthy hip, there is a visible gap between the ball and the socket. This gap is filled with cartilage, which doesn’t show up on X-rays.
In an arthritic hip, this gap disappears. You will see the ball touching the socket, confirming “bone-on-bone” contact. X-rays also reveal bone spurs, cysts, and the density of the bone (sclerosis). Doctors usually take X-rays while you are standing to see how the joint handles body weight.
Joint Space Narrowing
This is the hallmark of arthritis. As the cartilage wears away, the space between the bones shrinks. The severity of this narrowing helps stage the disease.
Osteophytes (Bone Spurs)
These look like small, jagged growths at the edges of the joint. They are the body’s attempt to stabilize the worn-out joint but often contribute to stiffness.
MRI: Looking at Soft Tissues
Magnetic Resonance Imaging (MRI) uses magnets and radio waves to create detailed images of soft tissues. While not always needed for severe arthritis (which is obvious on X-ray), MRI is crucial for early diagnosis.
If a patient has hip pain but normal-looking X-rays, an MRI can reveal avascular necrosis (dead bone) in its early stages before the bone collapses. It can also show tears in the labrum (the cartilage ring) or inflammation in the tendons and muscles. This helps rule out problems that might be resolved with arthroscopy rather than replacement.
CT Scans for Surgical Planning
A computed tomography (CT) scan is a 3D X-ray. It is often used for preoperative planning, especially if the surgeon uses robotic-assisted technology. The CT scan creates a precise 3D model of your unique pelvic and thigh bone anatomy.
This model allows the surgeon to size the implant perfectly before entering the operating room. The surgeon can precisely plan the placement of the socket cup to achieve equal leg length and hip stability. For patients with complex deformities or previous surgeries, a CT scan provides the roadmap needed for a safe procedure.
Diagnostic Injections
Sometimes, it is difficult to tell if pain is coming from the hip or the back (spinal stenosis). In these cases, a doctor might perform a diagnostic injection. Using ultrasound or X-ray guidance, they inject a local anesthetic (numbing medicine) directly into the hip joint.
If the pain disappears instantly, it confirms the hip is the source. If the pain remains, the problem likely originates in the back or nerves, and a hip replacement would not solve it. This simple test prevents unnecessary surgery.
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FREQUENTLY ASKED QUESTIONS
Does an X-ray hurt?
No, X-rays are painless. The scan is sensation-free, but you may have to twist your leg into certain positions to get the right angle, which can be uncomfortable if your hip is stiff.
Why do I need a CT scan if I have X-rays?
X-rays are 2D pictures. A CT scan gives a 3D view. This form of imaging is critical for measuring the rotation and depth of your socket, allowing for much more precise implant positioning, especially in robotic surgery.
Can I have an MRI if I have a pacemaker?
It depends on the device. Many modern pacemakers are MRI-safe, but older ones are not. You must tell your doctor and the MRI technician about any implants you have.
How do they measure leg length?
Doctors measure leg length on X-rays by drawing lines across the pelvis and comparing the position of the thigh bones. They also use tape measures during the physical exam. Restoring equal leg length is a key goal of surgery.
Will I need blood tests?
Yes. Before surgery, you will have blood tests to check your hemoglobin (red blood cells), kidney function, and clotting ability. This ensures you are healthy enough for anesthesia and the procedure.
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