Concentric Narrowing Of Hip Joint

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The hip is less commonly affected than the knee. The more classical changes are observed in patients with longstanding disease, especially those receiving corticosteroid therapy. Radiographic features include bone erosions, eb-urnation, and concentric articular narrowing. In addition, small cysts may be seen in scle-rosed periarticular bones. With concentric narrowing of the joint, the femoral head migrates axially within the acetabular fossa (Fig. 10.35A). Rarely, the femoral head migrates eccentrically in the superolateral direction. In contrast to osteoarthritis, osteophyto-sis and buttressing in the femoral neck are not prominent in rheumatoid arthritis.

Pinhole scintigraphy shows tracer to accumulate intensely in the entire joint and peri-articular bones, reflecting diffuse synovial inflammation with subchondral bone invasion (Fig. 10.35B). Articular narrowing is typically concentric and femoral migration is axial in direction as opposed to the eccentric narrowing and cranial or lateral dislocation in osteoarthritis (Fig. 9.10). As in the shoulder (Fig. 10.21A) and the knee (Fig. 10.33A), the cystic changes in the hip are indicated by intense tracer uptake (Fig. 10.36A).

Osteoarthritis Hip Joint Narrowing

Fig. 10.35A, B Concentric hip joint narrowing with axial migration of the femoral head in advanced rheumatoid arthritis. A Anteroposterior radiograph of the right hip in a 44-year-old male shows typical concentric narrowing and axial femoral head migration (arrow). B Anterior pinhole scan reveals intense concentric tracer uptake with axial migration of the femoral head (arrow)

Fig. 10.35A, B Concentric hip joint narrowing with axial migration of the femoral head in advanced rheumatoid arthritis. A Anteroposterior radiograph of the right hip in a 44-year-old male shows typical concentric narrowing and axial femoral head migration (arrow). B Anterior pinhole scan reveals intense concentric tracer uptake with axial migration of the femoral head (arrow)

Axial Narrowing Hip

Fig. 10.36A, B Intense tracer uptake in rheumatoid bone cysts in the hip. A Anterior pinhole scintigraph of the left hip in a 40-year-old woman with multiple rheumatoid cysts reveals general increase in tracer uptake with patchy intense tracer uptake in the femoral head (arrowheads). The joint is concentrically narrowed and the femoral head is axially migrated. B Anteroposterior radiograph delineates multiple small bone cysts (arrowheads), joint space narrowing, axial femoral head migration, and porosis

Fig. 10.36A, B Intense tracer uptake in rheumatoid bone cysts in the hip. A Anterior pinhole scintigraph of the left hip in a 40-year-old woman with multiple rheumatoid cysts reveals general increase in tracer uptake with patchy intense tracer uptake in the femoral head (arrowheads). The joint is concentrically narrowed and the femoral head is axially migrated. B Anteroposterior radiograph delineates multiple small bone cysts (arrowheads), joint space narrowing, axial femoral head migration, and porosis

Tomogram Femur

Fig. 10.37A, B Unilateral rheumatoid sacroiliitis. A Conventional tomogram of the left sacroiliac joint in a 53-year-old female shows sacral involvement of the disease with osteopenia and nebulous sclerosis in the sacral side (arrowheads). B Anterior pinhole scan reveals spinnakerlike tracer uptake in the sacral side (arrowheads)

Fig. 10.37A, B Unilateral rheumatoid sacroiliitis. A Conventional tomogram of the left sacroiliac joint in a 53-year-old female shows sacral involvement of the disease with osteopenia and nebulous sclerosis in the sacral side (arrowheads). B Anterior pinhole scan reveals spinnakerlike tracer uptake in the sacral side (arrowheads)

Sacroiliac Joints Sclerosis Iliac

Fig. 10.38A-C Joint preservation in sacroiliac rheumatoid arthritis. A Anteroposterior radiograph of the right sacroiliac joint in a 59-year-old female shows iliac bone involvement of the disease with eburnation and a relatively well-preserved joint (arrows). Note characteristic cyst-like bone resorption and reactive sclerosis (paired arrowheads). B Anterior planar scan reveals simple homogeneous uptake without diagnostic features (arrowheads). C Pinhole scan shows increased uptake localized to cyst-like bone resorption (paired arrowheads)

Fig. 10.38A-C Joint preservation in sacroiliac rheumatoid arthritis. A Anteroposterior radiograph of the right sacroiliac joint in a 59-year-old female shows iliac bone involvement of the disease with eburnation and a relatively well-preserved joint (arrows). Note characteristic cyst-like bone resorption and reactive sclerosis (paired arrowheads). B Anterior planar scan reveals simple homogeneous uptake without diagnostic features (arrowheads). C Pinhole scan shows increased uptake localized to cyst-like bone resorption (paired arrowheads)

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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