There is no lab test to identify the presence of hip osteoarthritis. Therefore, a doctor must use a comprehensive approach to diagnose the cause of a patient’s hip pain, beginning with a patient interview and physical exam.

A doctor may order diagnostic imaging such as an x-ray or MRI to help confirm osteoarthritis. Physicians also may use lab tests to rule out other possible conditions, such as rheumatoid arthritis.

The methods used to diagnose hip osteoarthritis are the same as those used to diagnose knee osteoarthritis. However, in general, hip osteoarthritis can be slightly more complicated to diagnose because hip pain can be more diffuse, radiating to the back and leg, and mimic other conditions, such as sacroiliac joint dysfunction.

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Hip Osteoarthritis
Hip osteoarthritis. Click to enlarge

Below is a more detailed description of the process physicians use to determine if a patient’s hip pain is caused by osteoarthritis.

Patient interview. During an appointment a doctor should ask the patient to describe the symptoms, including onset and pattern of pain and swelling, and how symptoms affect his or her lifestyle. A patient’s reported symptoms are important for diagnosis and treatment.

Physical exam. A doctor will test the hip’s range of motion and examine it for swelling and pain points. The doctor will also evaluate the patient’s gait.

Testing. The doctor will learn a great deal from the patient interview and physical exam. He or she will probably also order follow-up tests as part of the diagnostic process both to gain further information about the extent of the hip arthritis and/or to rule out other possible causes of the patient’s pain.

    X-rays. Hip joint degeneration is indicated on an X-ray by a loss of joint space between the femur and the acetabulum of the pelvic bone. An x-ray can also show bone spurs, or osteophytes. Osteophytes are a normal sign of aging, as almost everyone over age 50 has some, but they may proliferate as bones try to compensate for cartilage loss. The boney growths can create added friction and result in pain.

    A patient may have an x-ray that shows significant signs of hip osteoarthritis, referred to as radiographic hip osteoarthritis, and yet not be in pain. Conversely, some patients may not show notable radiographic osteoarthritis but be in significant pain if the damaged cartilage or bone spurs are in a sensitive spot. Therefore, an x-ray is just one tool to be used in conjunction with the patient interview and physical exam.

    MRI. Magnetic Resonance Imaging (MRI) may be ordered to provide additional detail, as this test provides images of the soft tissue (ligaments, tendons and muscle) as well as bone. A doctor may order an MRI of the hip if the x-rays are inconclusive or he or she suspects something other than osteoarthritis, such as damage to the hip’s labrum. An MRI is not needed in most cases, which is fortunate, since it is more time-consuming, requiring the patient to remain perfectly still for about 30 minutes, and significantly more expensive than an x-ray.

    Lab tests. Lab tests cannot identify the presence of hip osteoarthritis, but they can be used to rule out other problems, such as infection or gout, which can also cause hip pain. Lab tests may require a blood draw or an aspiration of the hip joint.

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Written by Andrew Cole, MD
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