X-rays of the hip joint are now useful not only in older patients in whom osteoarthritis or osteoarthritis of the joint is suspected, but also in younger patients.
Young people often come to the radiologist's office without osteoarthritis, but (unless there is a clearly defined problem) they are examined for femoroacetabular impingement or hip dysplasia.
A simple x-ray can evaluate both a normal and a dysplastic hip joint, or those with signs of damage.
In addition, pathological processes such as osteoarthritis, infections or tumors may be detected.
Advantages and disadvantages
X-ray of the hip joint, like other diagnostic methods, has its advantages. They include simplicity and accessibility, as well as low cost of the procedure. If the patient has an x-ray in hand, he can seek advice from different doctors, and the doctor will be able to monitor the dynamics of the disease during a re-examination.
Flaws:
- small doses of radiation exposure to the body;
- inability to fully assess joint function;
- there are other tissues near the area of study, so x-rays do not clearly visualize the structure of the joint;
- X-ray without contrast does not allow assessing the morphological structure of soft tissues;
- uninformative method.
Disadvantages of the diagnostic method
This procedure does not always help to find out an accurate diagnosis. Modern devices are distinguished by high image accuracy, but flat images do not provide comprehensive information about the location of various pathologies in all planes - using an image it is impossible to accurately determine the size, structure and volume of changes. To improve the information content of the data obtained as a result of the study, two cross-sectional studies are carried out at once: pictures are taken from different angles.
Main limitations of the study:
- inaccurate images;
- incomplete picture of the disease (it is impossible to examine adjacent soft tissues);
- age restrictions;
- X-rays of the femur are not prescribed for pregnant women (except for extreme cases when the benefit of the diagnosis exceeds the potential harm);
- radiation dose that is dangerous during subsequent repeated x-ray examinations.
Pictures are inaccurate if the limb was positioned incorrectly. The dense structure of the femur hides minor pathologies, preventing the problem from being identified in a timely manner. It is difficult to read images of patients with pathologies of the skeletal system - the loose structure of the skeleton affects the accuracy of the image.
Indications and contraindications
If a patient has pain in the hip area, then he may be prescribed an X-ray of the hip joint in order to determine the cause of the pain. This diagnostic method is considered the first method for most diseases of the musculoskeletal system.
With the help of radiography, such pathologies of the hip joint are revealed as:
- traumatic injuries (dislocations, fractures);
- degenerative changes in the joint (cystic degeneration, arthrosis, aseptic necrosis of the femoral head);
- bone tumor, metastasis;
- inflammatory conditions (arthritis, osteomyelitis);
- congenital pathologies (dysplasia, hypoplasia);
- metabolic disorders (gout, osteoporosis).
An absolute contraindication to such examinations is pregnancy at any time, as well as diseases of the thyroid gland, kidneys, and heart disease. Unless there is a compelling reason, it is best not to perform x-rays on children under 14 years of age. If such a procedure is carried out using a contrast agent, the list of contraindications will be much wider and includes the following body conditions:
- severe pathological changes in the liver and kidney;
- tuberculosis in the active phase;
- allergy to substances containing iodine;
- cardiovascular failure;
- serious condition of the patient.
Femoral neck osteosynthesis or endoprosthetics?
The duration of rehabilitation after internal osteosynthesis is on average 12 months, after endoprosthetics - 5-6 months. In the early postoperative period, all patients who have undergone hip replacement surgery are given antibiotic prophylaxis and prevention of thromboembolic complications.
Patients after osteosynthesis are on bed rest for the first 3-5 days. After this, they are allowed to move the limb and get out of bed. Later, patients are prescribed massage, physiotherapeutic procedures, exercise therapy, and swimming in the pool. Physiotherapy for hip fractures helps improve blood circulation in the joint area and thereby speed up recovery. The fixing plates or pins are removed only after the fracture has completely healed and the functional activity of the joint has been restored. Typically, this occurs 12-18 months after surgery.
In the case of endoprosthetics, the recovery period lasts much less. With the help of medical staff, a person can get out of bed on the second day after surgery. Soon he begins to move independently, with the help of crutches or a special walker. After another 2-3 months he may refuse them. If all the doctor’s recommendations are followed and proper rehabilitation is performed, the patient returns to his usual lifestyle within six months.
Preparation
- If you need to have an x-ray of your hip joint, no special preparation is usually required, but it is still worth paying attention to certain points.
- Since the area of interest is quite close to the intestine, its contents may affect image quality. In particular, this concerns the process of gas formation. To remove intestinal contents, it is recommended to perform a cleansing enema the evening before the test and the next morning. The patient can also take any laxative before the procedure.
- If radiography is performed with a contrast agent, it is necessary to conduct a test in advance to determine an allergic reaction. The procedure is carried out if the result is negative.
How to prepare for research?
An X-ray examination is carried out in a specialized office and in the direction of the attending physician. There is no special preparation for this type of study - the patient must obediently follow all recommendations of the medical staff.
Directly in the office, the patient is dressed in protective clothing (the upper torso is covered to minimize exposure to healthy tissue). Children undergo the procedure in the presence of their parents, who are also covered in specialized clothing.
Features of the procedure
- Before the procedure, the patient removes tight clothing, all jewelry and metal objects, because they will cause artifacts to appear in the images. To examine the hip joint, x-rays are performed in several projections. Before the x-ray is performed, protective lead plates are placed on the patient.
- To image the pelvic area, an X-ray machine sends a beam of rays through the hip joint. At this time, the radiation begins to scatter and stops, and the extent of such scattering depends on the density of the tissue being tested. At the same time, images of organs and tissues through which radiation has already passed begin to appear on the film. The photo clearly shows the bone, which has maximum density. A radiologist can use an X-ray image placed on a lighted screen to assess the internal structure of the joint.
- If an X-ray of the hip joint is performed, then, as a rule, an X-ray is taken in two projections. The procedure lasts about 10 minutes and the patient receives a radiation dose of 1.5 millisieverts.
Endoprosthetics as a treatment method
Due to poor blood supply and osteoporosis in older people, almost all fractures heal poorly. Moreover, the implantation of metal pins or plates activates the processes of osteolysis - destruction of bone tissue. As a result, after internal osteosynthesis, the condition of many patients only worsens.
Nowadays, the most effective method of treating hip fractures is endoprosthetics. Replacing fragments of the hip joint with artificial implants ensures early getting out of bed, can significantly shorten the rehabilitation period and restore the supporting function of the lower limb. This, in turn, makes it possible to avoid life-threatening complications from which many elderly people die in the first year after injury.
Fixing the components of the prosthesis with special cement ensures their reliable attachment to the surfaces of osteoporotic bones.
As practice has shown, total arthroplasty for femoral neck fractures gives favorable results in 90% of cases. This means that total hip replacement is much more effective than internal and external osteosynthesis.
Interpretation of X-rays
X-rays may have certain inaccuracies. This is due to the fact that the X-rays that are sent by the cathode ray tube diverge in a stream. If the subject of study is not in the middle, but at the edge of the image field, the image may be slightly elongated. In this case, the dimensions of the compounds under study also change.
The accuracy of diagnosis largely depends on how qualified the radiologist is. Each disease has its own characteristics, which are revealed in the pictures:
- Fractures are visible bone fragments;
- dislocations - you can see displacement of the articular surfaces;
- osteoarthritis - narrowing of the joint space, osteophytes;
- aseptic necrosis - bone regeneration, areas of osteosclerosis;
- osteoporosis - thinned structures and decreased bone density are clearly visible;
- dysplasia - reveals incomplete or abnormal development of the femoral head along with the articular cavity;
- tumors - foci of darkening, space-occupying formations.
Feasibility of the study
Radiation research methods are popular all over the world. Thanks to the images obtained as a result of the study, the condition and structural features of the bones can be assessed. The femur is one of the largest bones in the human body. Identifying problems in this part of the body is the primary task of a surgeon or traumatologist, to whom an adult or child can turn with complaints.
Pathological changes are clearly visible on the image, although they do not cause pronounced symptoms. The basis of the method is the effect of X-rays on various human tissues, including bones: each structure of the human body has its own density and is displayed differently in the images. Soft tissues transmit rays much better than bones, so the image evaluates the skeleton, not muscle tissue. Dense anatomical formations - bones - are detailed and enlarged in the resulting images: this research method in most cases eliminates the need for diagnostic surgery.
X-ray of the hip joint in children
X-rays of the hip joint are performed only according to strict indications, since X-rays can provoke hematological or oncological diseases in children. Therefore, research in children should be carried out by a high-level specialist who can conduct the examination with minimal harm to the child.
Children who are not yet a year old are usually prescribed an ultrasound scan, since in children under three months the muscles are still atrophied, and it is difficult to diagnose pathology such as hip dysplasia. In this case, x-rays cannot help. It is advisable to perform it when the cartilage is filled with calcium and turns into bone tissue.
How are x-rays done?
The study is carried out in a room that is equipped to protect health workers and patients from radiation. The patient needs to remove some of his clothing - unnecessary items and jewelry may interfere with the examination. On the table where the patient lies down, there are special markings that help to correctly position the person’s body to obtain clear images. The area of exposure to X-rays should be minimal: the image captures the head of the femur and its base.
Aprons with lead inserts cover the human thyroid gland and genitals, which are especially sensitive to radiation. For a direct projection, the patient lies straight on his back. Legs should be straight. In this position, it will be possible to obtain an image of the femur with joints. The lateral projection is scanned from above with the patient lying on the healthy side. The second leg and body are deviated to the side so as not to disturb the integral picture of one femur. The position must be fixed until the end of the x-ray examination.
As soon as the patient takes the correct position (with an apron and pads on), the medical staff goes to an adjacent radiation-protected room, in which the images are displayed on the screen through a control panel. If necessary, the patient changes position according to the instructions of the x-ray technician. On average, one plane (a picture from one angle) takes no more than 2-3 minutes - all this time the patient must remain motionless. After the procedure is completed, the patient waits for the results and interpretation of the resulting images.