Detecting hidden hip osteoarthritis: the value of hip-Inclusive lumbar radiography for lumbopelvic and lower limb pain.

PURPOSE: This study aimed to determine the clinical utility of a hip-inclusive lumbar spine X-ray imaging protocol (IHR) for outpatients with lumbopelvic and lower limb pain by comparing its effectiveness in identifying hip osteoarthritis (HOA) against a non-hip-inclusive protocol (NHR).

METHODS

We conducted a retrospective, cross-sectional study of 21,352 joints from patients (aged ≥ 20) presenting with lumbopelvic and lower limb pain between 2012 and 2021. The NHR group (2012-2016; 11,706 joints) received standard lumbar spine X-rays without hip inclusion, while the IHR group (2017-2021; 9,646 joints) received hip-inclusive lumbar spine X-rays. HOA was defined as Kellgren-Lawrence classification grade ≥ II. Statistical analyses included Wilcoxon rank-sum, Chi-squared, Fisher's exact, and Cochran-Armitage trend tests.

RESULTS

The IHR group had a significantly higher HOA identification rate (0.99%, 96/ 9646) compared to the NHR group (0.29%, 34/ 11706) (p < 0.001). Within the IHR group, females showed a significantly higher incidence of HOA (1.45%) than males (0.53%) (p < 0.001). A significant trend of increasing HOA incidence with age was observed in both sexes (p < 0.001), with the 70s showing the highest incidence. No significant association between HOA severity and gender was found.

CONCLUSION

Implementing the IHR protocol significantly improves the detection of HOA in patients with lumbopelvic and lower limb pain. This is particularly crucial for women and older patients, where HOA prevalence is higher. This enhanced diagnostic accuracy can lead to earlier, more appropriate interventions, ultimately improving patient care for this complex condition.