Weight-Bearing Hip X-rays for Osteoarthritis Assessment

Yes, weight-bearing hip X-rays are recommended for optimal detection of osteoarthritis features compared to non-weight-bearing views. 1, 2

Rationale for Weight-Bearing Views

Weight-bearing radiographs can detect dynamic abnormalities such as joint space narrowing that may not be apparent on non-weight-bearing radiographs 3
The European League Against Rheumatism (EULAR) specifically recommends consideration of radiographic views for optimizing detection of OA features 1
Weight-bearing radiographs decrease joint space width in osteoarthritic hips but not in normal joints, making them more sensitive for detecting pathological changes 2
The decrease in joint space is particularly significant in patients with joint space thickness less than 2.5mm, highlighting the value of weight-bearing views in detecting moderate to severe OA 2

Anteroposterior weight-bearing view of the hip is the primary view recommended 4
Additional right and left anterior oblique views (rotating the patient 55 degrees in each direction) may provide complementary information 4
Radiographically established OA of the hip is present when joint space width is less than 3 mm or less than the width in the contralateral hip joint 4
Weight-bearing radiographs of the hip should be used in preference to non-weight-bearing views in studies of hip OA 2

Studies comparing weight-bearing and non-weight-bearing positions show that maximum joint space narrowing (MaxJSN) is the most sensitive parameter for detecting changes in joint space width 2
The decrease in joint space width with weight-bearing is inversely correlated with joint space size, making weight-bearing views particularly valuable for monitoring disease progression 2
Radiographs centered on the hip provide better detection of joint space changes than pelvic X-rays 2
Conventional radiography remains the first-line imaging modality for diagnosing and monitoring OA due to accessibility, low cost, and ease of interpretation 5

While imaging is not required to make the diagnosis in patients with typical presentation of OA (usage-related pain, short duration morning stiffness, age >40, symptoms affecting one or a few joints), it is valuable for confirming diagnosis in atypical presentations 1, 6
For monitoring purposes, routine imaging in OA follow-up is not recommended unless there is unexpected rapid progression of symptoms or change in clinical characteristics 1
When imaging is needed, conventional radiography should be used before other modalities such as MRI or CT 1
Weight-bearing radiographs provide the most accurate assessment of functional joint space, which is crucial for clinical decision-making and monitoring disease progression 2, 7

Relying solely on non-weight-bearing views may underestimate the severity of joint space narrowing in OA 2
Joint space measurements from weight-bearing views are more clinically relevant as they reflect the functional status of the joint under physiological loading conditions 2, 7
Different radiographic views (anteroposterior vs. centered on the hip) may yield different results, with hip-centered views being more sensitive to detect changes between weight-bearing and non-weight-bearing positions 2
Standardized radiological procedures are essential for accurate and reproducible assessment of joint space width 2, 7