Challenge of the Week / Hip / 01.17.20

An 82-year-old female patient presents with a 3-month history of severe right groin pain. She has a medical history that is noteworthy for diabetes mellitus, hypertension, and stroke. She describes pain in the buttocks with ambulation, with radiation to the anterior aspect of the thigh and leg. She is able to ambulate, although with a mild limp. Her hip examination is normal, apart from iliopsoas weakness. Radiographs show mild osteoarthritis of the right hip. Which of the following is the appropriate next step?
  • Lower-extremity neurological examination
  • This patient’s symptom of buttock pain radiating to the anterior aspect of the thigh is most consistent with lumbar spine pathology; therefore, a lower- extremity neurological examination is warranted.

  • Magnetic resonance imaging (MRI) of the hip
  • Since this patient’s symptoms are most likely due to lumbar spine pathology, hip MRI is not indicated.

  • Total hip arthroplasty (THA)
  • Since this patient’s symptoms are most likely due to lumbar spine pathology and she only has mild hip degenerative changes on imaging, THA is not indicated at this time.

  • Hip arthroscopy
  • This patient’s symptoms are most likely due to lumbar spine pathology and her hip imaging shows degenerative changes, meaning hip arthroscopy is not indicated.

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