Hip OA Radiographic Pattern — SCE Rheumatology MCQ

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ModerateMusculoskeletal ImagingHip OA Radiographic PatternSCE Rheumatology

A 70-year-old man has gradually progressive unilateral groin pain and restriction of hip internal rotation. An anteroposterior pelvic radiograph shows osteophytes and subchondral sclerosis consistent with primary hip osteoarthritis. Which pattern of maximal joint-space narrowing is most likely?

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Correct answer: D — Superolateral (superior-pole) narrowing

The correct answer is D. Hip osteoarthritis is radiographically heterogeneous, but superior-pole joint-space loss is the predominant pattern, with superolateral narrowing particularly associated with men. This fits the older man with unilateral primary hip OA. Osteophytes, subchondral sclerosis and cysts commonly accompany the cartilage loss. Medial or axial narrowing is a recognised OA phenotype but is less frequent overall and is proportionately more common in women and bilateral disease. Concentric narrowing can occur but is not the typical male primary-OA pattern and should also prompt consideration of an inflammatory arthropathy in the appropriate clinical setting. Inferior-pole narrowing is not characteristic, while absence of narrowing is incompatible with established cartilage-loss OA when joint-space distribution is being classified.

Reference: Ledingham J, Dawson S, Preston B, Milligan G, Doherty M. Radiographic patterns and associations of osteoarthritis of the hip. Annals of the Rheumatic Diseases. 1992;51:1111-1116. https://ard.bmj.com/content/annrheumdis/76/7/1199.full.pdf