Hip Inflammatory Conditions: A Practical Differential Diagnosis Algorithmic Approach in Adults and Children

Jacob L. Jaremko; James Teh; Claudia Weidekamm; Lennart Jans; Nele Herregods

doi:10.1055/s-0039-1683966

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2019; 23(03): e1-e16
DOI: 10.1055/s-0039-1683966

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hip Inflammatory Conditions: A Practical Differential Diagnosis Algorithmic Approach in Adults and Children

Authors

Jacob L. Jaremko

¹Department of Radiology and Diagnostic Imaging, Faculty of Medicine, University of Alberta, Edmonton, Canada
James Teh

²Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
Claudia Weidekamm

³Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
Lennart Jans

⁴Department of Radiology and Medical Imaging, Ghent University Hospital, Gent, Belgium
Nele Herregods

⁴Department of Radiology and Medical Imaging, Ghent University Hospital, Gent, Belgium

Abstract

The child or adult patient presenting with acute hip pain in the absence of major trauma often presents a difficult diagnostic dilemma, due to the complex anatomy and diversity of pathology at the hip. A correct diagnosis is important because untreated hip inflammatory disease can lead to lifelong morbidity from structural damage at this weightbearing joint. An effective and efficient process of reaching an appropriate diagnosis often requires multiple imaging modalities overseen by careful clinical judgment. This article reviews an algorithmic approach to imaging the acutely painful hip, with attention to uses and limitations of each imaging modality, and it offers details on the key differential diagnoses in adults and children.

Keywords

hip - inflammation - arthritis - pediatric - adult

Full Text

References

References
1 Martin HD, Palmer IJ. History and physical examination of the hip: the basics. Curr Rev Musculoskelet Med 2013; 6 (03) 219-225
2 Schueller-Weidekamm C, Teh J. Inflammatory conditions of the hip. Semin Musculoskelet Radiol 2017; 21 (05) 589-603
3 Kanbe K, Oh K, Chiba J, Inoue Y, Taguchi M, Yabuki A. Efficacy of golimumab for preventing large joint destruction in patients with rheumatoid arthritis as determined by the ARASHI score. Mod Rheumatol 2017; 27 (06) 938-945
4 Schueller-Weidekamm C, Mascarenhas VV, Sudol-Szopinska I. , et al. Imaging and interpretation of axial spondylarthritis: the radiologist's perspective—consensus of the Arthritis Subcommittee of the ESSR. Semin Musculoskelet Radiol 2014; 18 (03) 265-279
5 Mandl P, Navarro-Compán V, Terslev L. , et al; European League Against Rheumatism (EULAR). EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015; 74 (07) 1327-1339
6 Campbell SE. Radiography of the hip: lines, signs, and patterns of disease. Semin Roentgenol 2005; 40 (03) 290-319
7 Plagou A, Teh J, Grainger AJ. , et al. Recommendations of the ESSR Arthritis Subcommittee on Ultrasonography in Inflammatory Joint Disease. Semin Musculoskelet Radiol 2016; 20 (05) 496-506
8 Martinoli C, Garello I, Marchetti A. , et al. Hip ultrasound. Eur J Radiol 2012; 81 (12) 3824-3831
9 Smith J, Hurdle MF, Weingarten TN. Accuracy of sonographically guided intra-articular injections in the native adult hip. J Ultrasound Med 2009; 28 (03) 329-335
10 Turmezei TD, Fotiadou A, Lomas DJ, Hopper MA, Poole KE. A new CT grading system for hip osteoarthritis. Osteoarthritis Cartilage 2014; 22 (10) 1360-1366
11 Descamps L, Olagne L, Merlin C, Cachin F, Soubrier M, Mathieu S. Utility of PET/CT in the diagnosis of inflammatory rheumatic diseases: a systematic review and meta-analysis. Ann Rheum Dis 2018; 77 (11) e81
12 Teh J, McQueen F, Eshed I, Plagou A, Klauser A. Advanced imaging in the diagnosis of gout and other crystal arthropathies. Semin Musculoskelet Radiol 2018; 22 (02) 225-236
13 Ragab Y, Emad Y, Abou-Zeid A. Bone marrow edema syndromes of the hip: MRI features in different hip disorders. Clin Rheumatol 2008; 27 (04) 475-482
14 Sudoł-Szopińska I, Jurik AG, Eshed I. , et al. Recommendations of the ESSR Arthritis Subcommittee for the Use of Magnetic Resonance Imaging in Musculoskeletal Rheumatic Diseases. Semin Musculoskelet Radiol 2015; 19 (04) 396-411
15 Neumann J, Zhang AL, Schwaiger BJ. , et al. Validation of scoring hip osteoarthritis with MRI (SHOMRI) scores using hip arthroscopy as a standard of reference. Eur Radiol 2019; 29 (02) 578-587
16 Herregods N, Vanhoenacker FM, Jaremko JL, Jans L. Update on pediatric hip imaging. Semin Musculoskelet Radiol 2017; 21 (05) 561-581
17 Vande Berg BE, Malghem JJ, Labaisse MA, Noel HM, Maldague BE. MR imaging of avascular necrosis and transient marrow edema of the femoral head. Radiographics 1993; 13 (03) 501-520
18 Teh J, Østergaard M. What the rheumatologist is looking for and what the radiologist should know in imaging for rheumatoid arthritis. Radiol Clin North Am 2017; 55 (05) 905-916
19 Miller E, Uleryk E, Doria AS. Evidence-based outcomes of studies addressing diagnostic accuracy of MRI of juvenile idiopathic arthritis. AJR Am J Roentgenol 2009; 192 (05) 1209-1218
20 Ranganath VK, Motamedi K, Haavardsholm EA. , et al. Comprehensive appraisal of magnetic resonance imaging findings in sustained rheumatoid arthritis remission: a substudy. Arthritis Care Res (Hoboken) 2015; 67 (07) 929-939
21 McQueen FM, Benton N, Perry D. , et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 2003; 48 (07) 1814-1827
22 McQueen FM. Bone marrow edema and osteitis in rheumatoid arthritis: the imaging perspective. Arthritis Res Ther 2012; 14 (05) 224
23 Birn J, Pruente R, Avram R, Eyler W, Mahan M, van Holsbeeck M. Sonographic evaluation of hip joint effusion in osteoarthritis with correlation to radiographic findings. J Clin Ultrasound 2014; 42 (04) 205-211
24 Bierma-Zeinstra SM, Bohnen AM, Verhaar JA, Prins A, Ginai-Karamat AZ, Laméris JS. Sonography for hip joint effusion in adults with hip pain. Ann Rheum Dis 2000; 59 (03) 178-182
25 McQueen FM. A vital clue to deciphering bone pathology: MRI bone oedema in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 2007; 66 (12) 1549-1552
26 Popovich I, Lee AC, Doyle A. , et al. A comparative MRI study of cartilage damage in gout versus rheumatoid arthritis. J Med Imaging Radiat Oncol 2015; 59 (04) 431-435
27 Chan BY, Gill KG, Rebsamen SL, Nguyen JC. MR imaging of pediatric bone marrow. Radiographics 2016; 36 (06) 1911-1930
28 Varma DG, Richli WR, Charnsangavej C, Samuels BI, Kim EE, Wallace S. MR appearance of the distended iliopsoas bursa. AJR Am J Roentgenol 1991; 156 (05) 1025-1028
29 Pfirrmann CW, Chung CB, Theumann NH, Trudell DJ, Resnick D. Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae—MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers. Radiology 2001; 221 (02) 469-477
30 Hirschmann A, Falkowski AL, Kovacs B. Greater trochanteric pain syndrome: abductors, external rotators. Semin Musculoskelet Radiol 2017; 21 (05) 539-546
31 Jans L, van Langenhove C, Van Praet L. , et al. Diagnostic value of pelvic enthesitis on MRI of the sacroiliac joints in spondyloarthritis. Eur Radiol 2014; 24 (04) 866-871
32 Gold SL, Burge AJ, Potter HG. MRI of hip cartilage: joint morphology, structure, and composition. Clin Orthop Relat Res 2012; 470 (12) 3321-3331
33 Buchbender C, Scherer A, Kröpil P. , et al. Cartilage quality in rheumatoid arthritis: comparison of T2* mapping, native T1 mapping, dGEMRIC, ΔR1 and value of pre-contrast imaging. Skeletal Radiol 2012; 41 (06) 685-692
34 Narváez J, Narváez JA, de Albert M, Gómez-Vaquero C, Nolla JM. Can magnetic resonance imaging of the hand and wrist differentiate between rheumatoid arthritis and psoriatic arthritis in the early stages of the disease?. Semin Arthritis Rheum 2012; 42 (03) 234-245
35 Aletaha D, Funovits J, Smolen JS. Physical disability in rheumatoid arthritis is associated with cartilage damage rather than bone destruction. Ann Rheum Dis 2011; 70 (05) 733-739
36 Barnabe C, Toepfer D, Marotte H. , et al; SPECTRA Collaboration. Definition for rheumatoid arthritis erosions imaged with high resolution peripheral quantitative computed tomography and interreader reliability for detection and measurement. J Rheumatol 2016; 43 (10) 1935-1940
37 Døhn UM, Ejbjerg BJ, Hasselquist M. , et al. Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography. Arthritis Res Ther 2008; 10 (01) R25
38 Døhn UM, Ejbjerg BJ, Court-Payen M. , et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther 2006; 8 (04) R110
39 Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007; 369 (9570): 1379-1390
40 Chen HA, Chen CH, Liao HT. , et al. Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis. Semin Arthritis Rheum 2011; 40 (06) 552-558
41 Appel H, Kuhne M, Spiekermann S. , et al. Immunohistochemical analysis of hip arthritis in ankylosing spondylitis: evaluation of the bone-cartilage interface and subchondral bone marrow. Arthritis Rheum 2006; 54 (06) 1805-1813
42 Huang ZG, Zhang XZ, Hong W. , et al. The application of MR imaging in the detection of hip involvement in patients with ankylosing spondylitis. Eur J Radiol 2013; 82 (09) 1487-1493
43 Chen D, Yuan S, Zhan Z. , et al. Early-stage hip involvement in patients with ankylosing spondylitis: a Chinese study based on magnetic resonance imaging. Mod Rheumatol 2016; 26 (06) 933-939
44 Dwosh IL, Resnick D, Becker MA. Hip involvement in ankylosing spondylitis. Arthritis Rheum 1976; 19 (04) 683-692
45 Michet CJ, Mason TG, Mazlumzadeh M. Hip joint disease in psoriatic arthritis: risk factors and natural history. Ann Rheum Dis 2005; 64 (07) 1068-1070
46 Duthie RB, Harris CM. A radiographic and clinical survey of the hip joint in sero-positive rheumatoid arthritis. Acta Orthop Scand 1969; 40 (03) 346-364
47 Eberhardt K, Fex E, Johnsson K, Geborek P. Hip involvement in early rheumatoid arthritis. Ann Rheum Dis 1995; 54 (01) 45-48
48 Eberhardt KB, Fex E. Functional impairment and disability in early rheumatoid arthritis—development over 5 years. J Rheumatol 1995; 22 (06) 1037-1042
49 Dasgupta B, Cimmino MA, Kremers HM. , et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum 2012; 64 (04) 943-954
50 Cantini F, Niccoli L, Nannini C. , et al. Inflammatory changes of hip synovial structures in polymyalgia rheumatica. Clin Exp Rheumatol 2005; 23 (04) 462-468
51 Camellino D, Cimmino MA. Imaging of polymyalgia rheumatica: indications on its pathogenesis, diagnosis and prognosis. Rheumatology (Oxford) 2012; 51 (01) 77-86
52 Lavado-Pérez C, Martínez-Rodríguez I, Martínez-Amador N. , et al. (18)F-FDG PET/CT for the detection of large vessel vasculitis in patients with polymyalgia rheumatica. Rev Esp Med Nucl Imagen Mol 2015; 34 (05) 275-281
53 Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015; 11 (11) 649-662
54 Ahmad Z, Gupta AK, Sharma R, Bhalla AS, Kumar U, Sreenivas V. Dual energy computed tomography: a novel technique for diagnosis of gout. Int J Rheum Dis 2016; 19 (09) 887-896
55 Parhami N, Feng H. Gout in the hip joint. Arthritis Rheum 1993; 36 (07) 1026
56 Terslev L, Gutierrez M, Christensen R. , et al; OMERACT US Gout Task Force. Assessing elementary lesions in gout by ultrasound: results of an OMERACT patient-based agreement and reliability exercise. J Rheumatol 2015; 42 (11) 2149-2154
57 Zhang W, Doherty M, Pascual E. , et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis 2011; 70 (04) 571-575
58 Coral A, Hardy G, Harvey A, Smith RM. Case report: tumoral pseudogout of the hip joint. Clin Radiol 1996; 51 (12) 889-891
59 Molloy ES, McCarthy GM. Calcium crystal deposition diseases: update on pathogenesis and manifestations. Rheum Dis Clin North Am 2006; 32 (02) 383-400, vii vii
60 Klontzas ME, Vassalou EE, Zibis AH, Karantanas AH. Hydroxyapatite deposition disease around the hip: outcomes of CT-guided treatment. Diagn Interv Radiol 2016; 22 (05) 466-470
61 Cobby MJ, Adler RS, Swartz R, Martel W. Dialysis-related amyloid arthropathy: MR findings in four patients. AJR Am J Roentgenol 1991; 157 (05) 1023-1027
62 Ayers DC, Athanasou NA, Woods CG, Duthie RB. Dialysis arthropathy of the hip. Clin Orthop Relat Res 1993; (290) 216-224
63 Otake S, Tsuruta Y, Yamana D, Mizutani H, Ohba S. Amyloid arthropathy of the hip joint: MR demonstration of presumed amyloid lesions in 152 patients with long-term hemodialysis. Eur Radiol 1998; 8 (08) 1352-1356
64 Jaremko JL, Lambert RG, Zubler V. , et al. Methodologies for semiquantitative evaluation of hip osteoarthritis by magnetic resonance imaging: approaches based on the whole organ and focused on active lesions. J Rheumatol 2014; 41 (02) 359-369
65 Ledingham J, Dawson S, Preston B, Milligan G, Doherty M. Radiographic patterns and associations of osteoarthritis of the hip. Ann Rheum Dis 1992; 51 (10) 1111-1116
66 Zalavras CG, Rigopoulos N, Lee J, Learch T, Patzakis MJ. Magnetic resonance imaging findings in hematogenous osteomyelitis of the hip in adults. Clin Orthop Relat Res 2009; 467 (07) 1688-1692
67 Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg 2009; 23 (02) 80-89
68 Karchevsky M, Schweitzer ME, Morrison WB, Parellada JA. MRI findings of septic arthritis and associated osteomyelitis in adults. AJR Am J Roentgenol 2004; 182 (01) 119-122
69 Chai JW, Hong SH, Choi JY. , et al. Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. Radiographics 2010; 30 (03) 737-749
70 Allen SD, Saifuddin A. Imaging of intra-articular osteoid osteoma. Clin Radiol 2003; 58 (11) 845-852
71 Rolvien T, Zustin J, Mussawy H, Schmidt T, Pogoda P, Ueblacker P. Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain. BMC Musculoskelet Disord 2016; 17 (01) 455
72 West RB, Rubin BP, Miller MA. , et al. A landscape effect in tenosynovial giant-cell tumor from activation of CSF1 expression by a translocation in a minority of tumor cells. Proc Natl Acad Sci U S A 2006; 103 (03) 690-695
73 Cotten A, Flipo RM, Chastanet P, Desvigne-Noulet MC, Duquesnoy B, Delcambre B. Pigmented villonodular synovitis of the hip: review of radiographic features in 58 patients. Skeletal Radiol 1995; 24 (01) 1-6
74 Chen H, Yu X, Wu C. Fast segmentation for medical ultrasound image based on parametric level set active contour model. J Med Imaging Health Inform 2018; 8: 1415-1421
75 Cheng XG, You YH, Liu W, Zhao T, Qu H. MRI features of pigmented villonodular synovitis (PVNS). Clin Rheumatol 2004; 23 (01) 31-34
76 Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics 2007; 27 (05) 1465-1488
77 Kramer J, Recht M, Deely DM. , et al. MR appearance of idiopathic synovial osteochondromatosis. J Comput Assist Tomogr 1993; 17 (05) 772-776
78 Kim SH, Hong SJ, Park JS. , et al. Idiopathic synovial osteochondromatosis of the hip: radiographic and MR appearances in 15 patients. Korean J Radiol 2002; 3 (04) 254-259
79 Vogler III JB, Murphy WA. Bone marrow imaging. Radiology 1988; 168 (03) 679-693
80 Glickstein MF, Burk Jr DL, Schiebler ML. , et al. Avascular necrosis versus other diseases of the hip: sensitivity of MR imaging. Radiology 1988; 169 (01) 213-215
81 Vardhan H, Tripathy SK, Sen RK, Aggarwal S, Goyal T. Epidemiological profile of femoral head osteonecrosis in the North Indian population. Indian J Orthop 2018; 52 (02) 140-146
82 Zurlo JV. The double-line sign. Radiology 1999; 212 (02) 541-542
83 Jawad MU, Haleem AA, Scully SP. In brief: Ficat classification: avascular necrosis of the femoral head. Clin Orthop Relat Res 2012; 470 (09) 2636-2639
84 Cahir JG, Toms AP. Regional migratory osteoporosis. Eur J Radiol 2008; 67 (01) 2-10
85 Balakrishnan A, Schemitsch EH, Pearce D, McKee MD. Distinguishing transient osteoporosis of the hip from avascular necrosis. Can J Surg 2003; 46 (03) 187-192
86 Vande Berg BC, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE. Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology 1999; 212 (02) 527-535
87 Zucker EJ, Lee EY, Restrepo R, Eisenberg RL. Hip disorders in children. AJR Am J Roentgenol 2013; 201 (06) W776–W796
88 Hubbard AM. Imaging of pediatric hip disorders. Radiol Clin North Am 2001; 39 (04) 721-732
89 Miralles M, Gonzalez G, Pulpeiro JR. , et al. Sonography of the painful hip in children: 500 consecutive cases. AJR Am J Roentgenol 1989; 152 (03) 579-582
90 Do TT. Transient synovitis as a cause of painful limps in children. Curr Opin Pediatr 2000; 12 (01) 48-51
91 Sarwar ZU, DeFlorio R, Catanzano TM. Imaging of nontraumatic acute hip pain in children: multimodality approach with attention to the reduction of medical radiation exposure. Semin Ultrasound CT MR 2014; 35 (04) 394-408
92 Kwack KS, Cho JH, Lee JH, Cho JH, Oh KK, Kim SY. Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR Am J Roentgenol 2007; 189 (02) 437-445
93 Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007; 369 (9563): 767-778
94 Petty RE, Southwood TR, Manners P. , et al; International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31 (02) 390-392
95 Sheybani EF, Khanna G, White AJ, Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics 2013; 33 (05) 1253-1273
96 Williams RA, Ansell BM. Radiological findings in seropositive juvenile chronic arthritis (juvenile rheumatoid arthritis) with particular reference to progression. Ann Rheum Dis 1985; 44 (10) 685-693
97 Buchmann RF, Jaramillo D. Imaging of articular disorders in children. Radiol Clin North Am 2004; 42 (01) 151-168 , vii
98 Eshed I, Bollow M, McGonagle DG. , et al. MRI of enthesitis of the appendicular skeleton in spondyloarthritis. Ann Rheum Dis 2007; 66 (12) 1553-1559
99 Herregods N, Dehoorne J, Joos R. , et al. Diagnostic value of MRI features of sacroiliitis in juvenile spondyloarthritis. Clin Radiol 2015; 70 (12) 1428-1438
100 Herregods N, Dehoorne J, Pattyn E. , et al. Diagnostic value of pelvic enthesitis on MRI of the sacroiliac joints in enthesitis related arthritis. Pediatr Rheumatol Online J 2015; 13 (01) 46
101 Tsung JW, Blaivas M. Emergency department diagnosis of pediatric hip effusion and guided arthrocentesis using point-of-care ultrasound. J Emerg Med 2008; 35 (04) 393-399
102 Rosenfeld S, Bernstein DT, Daram S, Dawson J, Zhang W. Predicting the presence of adjacent infections in septic arthritis in children. J Pediatr Orthop 2016; 36 (01) 70-74
103 Schmit P, Glorion C. Osteomyelitis in infants and children. Eur Radiol 2004; 14 (Suppl. 04) L44-L54
104 Blickman JG, van Die CE, de Rooy JW. Current imaging concepts in pediatric osteomyelitis. Eur Radiol 2004; 14 (Suppl. 04) L55-L64
105 Klein JD, Leach KA. Pediatric pelvic osteomyelitis. Clin Pediatr (Phila) 2007; 46 (09) 787-790
106 Khanna G, Sato TS, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 2009; 29 (04) 1159-1177
107 von Kalle T, Heim N, Hospach T, Langendörfer M, Winkler P, Stuber T. Typical patterns of bone involvement in whole-body MRI of patients with chronic recurrent multifocal osteomyelitis (CRMO). RoFo Fortschr Geb Rontgenstr Nuklearmed 2013; 185 (07) 655-661
108 Huber AM, Lam PY, Duffy CM. , et al. Chronic recurrent multifocal osteomyelitis: clinical outcomes after more than five years of follow-up. J Pediatr 2002; 141 (02) 198-203