Imaging of the chronic painful adult hip

Adult hip pathologies are mainly represented by the degenerative disease, s o called "osteoarthrosis, or more precisely coxarthrosis", The means of imaging are exposed, according to their specific value: X Rays (measurement of the characteristic angles of the adult hip), Arthrography, CT Scanner, Arthro-CT Scanner, MRI, Bone Scintigraphy, Ultrasonography. Cl inical findings differentiate a mechanical syndrome and an inflammatory syn drome. The coxarthrosis is the most frequent, under two forms: primary (idiopathic ) coxarthrosis and secondary coxarthrosis. Primary (idiopathic) coxarthrosis has a localised narrowing of the joint sp ace, osteophyte formation, subchondral sclerosis, cyst formation. The destr uction progresses slowly, in 10 to 15 years leading to a complete destructi on. Bilaterality is frequent. it is treated with total hip prosthesis. Ther e is a rapid form (1 to 2 years) (Postel's Disease). Secondary coxarthrosis occurs after architectural vice, chondral diseases, lack of balance between the size of the bead and the acetabulum as in the c ase of previous fracture or dislocation, avascular bone necrosis of the hea d of the femur, Paget's disease. Calcium pyrophosphate Deposition disease ( CPPD) involves mostly aged women, and also leads to coxarthrosis. Avascular bone necrosis of the head of the femur involves young adults. Bil ateral involvement are frequent. MRI is the most sensitive and the most spe cific means of early diagnosis. The area of bone necrosis appears as well d efined modifications of the upper head of the femur, precisely surrounded b y a low signal intensity line on both T1 and T2 weighted imaging. MRI shows articular effusion, bone marrow edema, Scintigraphy gives early findings w hich are a characteristic, but non specific, I-rot spot. CT scanner is used for hip destruction evaluation. Algodystrophy: transient osteoporosis of the hip has a cyclic course, lasti ng 3 to 9 months. MRI shows an inflammatory pat tern in the area of the pro cess(dark in T1 and white in T2, with positive Gadolinium response), Scinti graphy is positive. Staphylococcus location in the hip can be acute or chronic. MRI shows joint effusion, cystic formation and subchondral non specific modifications. Tub erculosis of the hip joint is relatively rare. Greater trochanteric tubercu lous involvement is possible under special contexts. Chronic inflammatory diseases are represented by Rheumatoid Arthritis, Spon dylarthritis and other chronic inflammatory diseases. Synovial tumors such as Pigmented Villo Nodular Synovitis, Primary Osteocho ndromatosis. synovial sarcoma have special presentations. The subchondral b one can be involved by amorphous depositions such as in tophaceous gout, di fferent varieties of lipidosis, amyloidosis, reticulo histiocytosis. Peri arthropathies are enthesopathies in the anterior rectus tendon, calcif ying lendonitis (not to be confused with calcifying soft tissue tumor/chond rosarcoma). The pelvis bone and the femur are involved by primary and secondary tumors or by insufficiency fractures which can mislead to hip pathologies.