Why are you being sent to hip surgery?March 22, 2016 March 22, 2016
Why are you being sent to hip surgery?
A patient will come into the office with an all too familiar story: He/she started having some minor hip pain. A routine MRI was ordered. A surgical date was made.
The patient had no idea that their hip pain was serious enough to get a surgical recommendation. THE MRI, the patient is told, revealed extensive damage.
OR DID IT? Doctors now are questioning the “rubber stamp” MRI > diagnosis > surgery recommendations for patients exhibiting little to no hip pain. They ask – Do these patients really need a surgery?
In a recent medical paper, radiologists declared that MRI for the detection of cartilage damage is – at best – fair.1
MRI use as support for surgical procedure should be questioned.
Other investigators went further. In one study researchers took forty-five volunteers with no history of hip pain, symptoms, injury, or surgery for recruitment into their study. The subjects underwent a MRI scan which were reviewed by 3 fellowship-trained musculoskeletal radiologists.
The scans were mixed randomly with 19 scans from symptomatic patients to blind the radiologists to the possibility of patient symptoms. An abnormal finding was considered positive when 2 of 3 radiologists agreed on its presence.
The average age of volunteers was 37.8 years
(range, 15-66 y); 60% were men.
Here is all the problems they saw:
- Labral tears were identified in 69% of hips,
- Cartilage or chondral defects in 24%,
- A ligament tear – specifically the ligamentum teres 2.2%
- labral/paralabral cysts in 13%
- acetabular bone edema in 11%,
- fibrocystic changes of the head/neck junction in 22%
- rim fractures in 11%
- subchondral cysts in 16%
- osseous bumps in 20%.
BUT all the patients, with all these symptoms had no pain
CONCLUSION:Magnetic resonance images of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears being identified in 69% of the joints. 2
This research supports a February 2012 recommendation presented at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Specialty Day meeting that suggested that when doctors treat people with hip pain, “physicians should not replace clinical observation with the use of magnetic resonance images (MRI).”3
At the Magaziner Center for Wellness, we rarely if ever rely on an MRI. In our opinion these tests are a waste of money. A patient can come in with a big file of films and scans that cost them a lot of money out-of-pocket, and typically, there will be no useful information that will help us get the athlete back on the field or a patient back to work. A skilled physician can make a more accurate determination of an injury and treatment plan with a careful physical examination and history.
Unfortunately, there is a certain appeal to the patient to get an MRI, especially the athlete who thinks it is part of the normal process of treatment. It is sometimes difficult to get the patient to understand that when they get an MRI there will be a recommendation for a surgery that many times is unnecessary.
Do you have questions about Hip pain?
Call US 856-324-6033 OR email us at: info@DrMagaziner.com
1. Xu L, Hayashi D, Guermazi A, Hunter DJ, Li L, Winterstein A, Bohndorf K, Roemer FW. The diagnostic performance of radiography for detection of osteoarthritis-associated features compared with MRI in hip joints with chronic pain. Skeletal Radiol. 2013 Oct;42(10):1421-8. doi: 10.1007/s00256-013-1675-7. Epub 2013 Jul 11.
2. Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study. Am J Sports Med. 2012 Oct 25. [Epub ahead of print]
3. Treatment for Hip Conditions Should Not Rest Solely on MRI Scans. AOSSM February 11, 2012.