Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

BMC Musculoskelet Disord. 2017 Mar 21;18(1):120. doi: 10.1186/s12891-017-1485-5.


Background: Patients with groin, hip and pelvic pain but normal findings on MRI and minimal changes on x-ray can be a diagnostic problem. This paper looks at the arthroscopic findings of patients who have had hip pain and a positive response to an intra-articular anaesthetic but have non-contributory imaging. We hypothesized that standard MRI's were missing significant pathology and if there was a response to intra-articular local anaesthesia, pathology found during arthroscopy was likely.

Methods: A retrospective review of all hip arthroscopies performed from March 2011 to January 2015 by two orthopaedic surgeons specializing in hip arthroscopy was conducted to identify patients with clinically suspected intra-articular hip pathology despite a normal MRI report and X-ray. Clinical suspicion of intra-articular hip pathology was confirmed with a positive response to a fluoroscopically guided intra-articular injection of local anaesthetic and corticosteroid. Pathologic findings were collated from the standardised operative notes.

Results: Fifty-three hip arthroscopies performed in 51 patients met the inclusion criteria from a total of 1348 hip arthroscopies performed over a 46-month period. All but one of the 53 (98%) hips had arthroscopically confirmed pathology. Mean patient age was 32.5 years [15 to 67 years] with 40 (78%) females and 11 (22%) males. 92.5% of the hips (49/53) were FADIR (flexion, adduction and internal rotation) positive on clinical examination, giving this test a positive predictive value of 98% (95% CI: 89.31 to 99.67%) for intra-articular pathology.

Conclusions: In patients with a normal MRI without contrast and a positive response (relief of pain) to an intra-articular injection that failed conservative management, there is a 98% chance of intra-articular hip pathology being discovered on hip arthroscopy.

Keywords: Hip arthroscopy; Image-guided injection; Intra-articular hip pathology; Magnetic resonance imaging.

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage
  • Adult
  • Aged
  • Anesthetics, Local / administration & dosage
  • Arthralgia / diagnostic imaging*
  • Arthralgia / pathology
  • Arthralgia / physiopathology
  • Arthralgia / therapy
  • Arthroscopy*
  • Biomechanical Phenomena
  • Female
  • Hip Joint / diagnostic imaging*
  • Hip Joint / pathology
  • Hip Joint / physiopathology
  • Humans
  • Injections, Intra-Articular
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Pelvic Pain / diagnostic imaging*
  • Pelvic Pain / pathology
  • Pelvic Pain / physiopathology
  • Pelvic Pain / therapy
  • Predictive Value of Tests
  • Range of Motion, Articular
  • Retrospective Studies
  • Young Adult


  • Adrenal Cortex Hormones
  • Anesthetics, Local