What is the best X-ray (X-radiation) for diagnosing left hip pain?

Best X-ray for Left Hip Pain

For patients with left hip pain, standard anteroposterior (AP) radiographs of the pelvis plus a lateral view of the affected hip should be obtained as the initial imaging study before proceeding to more advanced imaging. 1, 2

Initial Radiographic Evaluation

• AP pelvis view: Provides visualization of both hips simultaneously, allowing comparison between sides and evaluation of pelvic alignment
• Lateral view of the affected hip: Complements the AP view by showing the femoral head-neck junction from a different angle

Specialized Views (when indicated):

• False profile view: Particularly useful for evaluating hip dysplasia
• Dunn view: Better visualizes the femoral head-neck junction for femoroacetabular impingement (FAI) 1

Rationale for Radiographs as First-Line Imaging

• Excellent screening tool for common disorders such as arthritis, fractures, and bone tumors
• Helps guide selection of additional imaging techniques if needed
• Provides baseline for comparison with advanced imaging studies 1
• Low cost and widely available compared to advanced imaging

When Standard Radiographs Are Insufficient

If radiographs are negative, equivocal, or non-diagnostic, further imaging is indicated based on clinical suspicion:

For suspected soft tissue abnormality (tendinitis, bursitis):

• MRI without contrast (rating 9/9) is the preferred next step 1, 2
• Ultrasound may be considered for specific extra-articular conditions (rating 7/9) 2

For suspected labral tear or femoroacetabular impingement:

• MR arthrography (rating 9/9) is the preferred next step 1, 2

For suspected cartilage damage:

• MRI without contrast or MR arthrography (both rated 9/9) 1
• CT arthrography (rating 8/9) is an alternative 1

Common Pitfalls to Avoid

1. Imaging only the symptomatic hip: A view of the pelvis plus additional imaging of the proximal femur is superior to radiographs limited to the ipsilateral hip 1

2. Improper positioning: Pelvic orientation can affect measurements of hip joint space width, though studies suggest minimal impact within normal ranges of positioning 3

3. Overlooking referred pain: Hip pain may originate from the lumbar spine, sacroiliac joints, or knee. When these sources are suspected, MRI of the hip without contrast (rating 9/9) and image-guided anesthetic injection (rating 8/9) can help exclude the hip as the source 1

4. Relying solely on radiographs for soft tissue pathology: Radiographs have limited sensitivity for soft tissue abnormalities, which are better evaluated with MRI or ultrasound 1

By following this evidence-based approach to imaging for left hip pain, clinicians can efficiently diagnose the underlying cause and develop an appropriate treatment plan that addresses the true source of pain.