{"id":5057,"date":"2025-12-22T10:48:01","date_gmt":"2025-12-22T10:48:01","guid":{"rendered":"https:\/\/www.chirurgiedelahanche.com\/blog\/implanter-prothese-hanche-sur-coxopathie-a-radiographies-normales\/"},"modified":"2025-12-22T11:00:31","modified_gmt":"2025-12-22T11:00:31","slug":"implanting-hip-prosthesis-in-coxopathy-with-normal-radiographs","status":"publish","type":"post","link":"https:\/\/www.chirurgiedelahanche.com\/en\/blog\/hip-surgery\/implanting-hip-prosthesis-in-coxopathy-with-normal-radiographs\/","title":{"rendered":"Implanting a hip prosthesis in coxopathy with normal radiographs"},"content":{"rendered":"<h2>When radiographs are normal despite pain<\/h2>\n<p>In some cases, patients present with <strong>mechanical hip pain<\/strong> despite <strong>perfectly normal radiographs<\/strong>.<br \/>\nThe typical scenario involves a 50-year-old woman with <strong>mechanical and positional groin pain<\/strong>, limiting daily activities, walking, and sports.<\/p>\n<p>When hip radiographs are strictly normal (no joint space narrowing, no osteophytes, no subchondral cysts, and no signs of <strong><a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/pathologies\/coxarthrosis\/\"> osteoarthritis<\/a> <\/strong>) treatment is often limited to analgesics, anti-inflammatory drugs, and injections, and any surgical option is usually ruled out.<\/p>\n<p>In certain cases, however, this approach represents a <strong>strategic error<\/strong>, as some cartilage lesions with normal radiographs are <strong>resistant to medical treatment<\/strong>.<\/p>\n<h2>The decisive contribution of cross-sectional imaging<\/h2>\n<p>Cross-sectional imaging provides essential diagnostic information.<\/p>\n<h3>The role of hip mri<\/h3>\n<p>An MRI focused on the coxofemoral joint may reveal:<\/p>\n<ul>\n<li>joint effusion<\/li>\n<li>advanced chondropathy<\/li>\n<li>subchondral bone marrow edema in the weight-bearing zone, sometimes bipolar<\/li>\n<\/ul>\n<h3>The value of CT arthrography<\/h3>\n<p>CT arthrography allows precise visualization of cartilage integrity and may demonstrate <strong>deep and extensive femoral chondropathy (grade IV)<\/strong>, confirming severe joint suffering.<br \/>\nIn some cases, the chondropathy is <strong>bipolar<\/strong>, affecting both femoral and acetabular cartilage.<\/p>\n<p>Thus, <strong>severe and extensive chondropathy may exist despite normal radiographs<\/strong>.<\/p>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-5053 size-full\" src=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale.jpg\" alt=\"\" width=\"1907\" height=\"2152\" srcset=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale.jpg 1907w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale-266x300.jpg 266w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale-907x1024.jpg 907w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale-768x867.jpg 768w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale-1361x1536.jpg 1361w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale-1815x2048.jpg 1815w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale-266x300@2x.jpg 532w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale-907x1024@2x.jpg 1814w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/radiographie-normale-768x867@2x.jpg 1536w\" sizes=\"(max-width: 1907px) 100vw, 1907px\" \/><\/p>\n<h2>Clinical examination: an essential step<\/h2>\n<p>During consultation, physical examination evaluates passive hip range of motion in all planes. Marked pain is often elicited during coxopathy tests, particularly the <strong>FABER test<\/strong> and the <strong>FADIR test<\/strong>.<\/p>\n<p>A complete neurological examination is mandatory to rule out radiculopathy, sensorimotor deficits, or absent reflexes. Abdominal wall hernias and all sources of extra-articular pain must also be excluded.<\/p>\n<h2>Medical management of cartilage lesions with normal radiographs<\/h2>\n<p>In cases of severe chondropathy with normal radiographs, treatment primarily relies on <strong>joint preservation<\/strong>, avoiding high-impact sports and favoring gentle, regular, low-load activities such as cycling and swimming.<\/p>\n<p>Medical treatment includes:<\/p>\n<ul>\n<li>analgesics tailored to pain intensity<\/li>\n<li>nonsteroidal anti-inflammatory drugs administered intermittently<\/li>\n<\/ul>\n<p>In some cases, <strong>intra-articular injections<\/strong> can be highly effective (hyaluronic acid, corticosteroid, PRP).<\/p>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-5047 size-full\" src=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/chondropathie-profonde-et-visible-a-larthroscanner.jpg\" alt=\"\" width=\"1682\" height=\"1439\" srcset=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/chondropathie-profonde-et-visible-a-larthroscanner.jpg 1682w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/chondropathie-profonde-et-visible-a-larthroscanner-300x257.jpg 300w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/chondropathie-profonde-et-visible-a-larthroscanner-1024x876.jpg 1024w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/chondropathie-profonde-et-visible-a-larthroscanner-768x657.jpg 768w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/chondropathie-profonde-et-visible-a-larthroscanner-1536x1314.jpg 1536w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/12\/chondropathie-profonde-et-visible-a-larthroscanner-300x257@2x.jpg 600w\" sizes=\"(max-width: 1682px) 100vw, 1682px\" \/><\/p>\n<h2>When should a hip prosthesis be considered despite normal radiographs?<\/h2>\n<p>When well-conducted medical treatment fails, <a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/treatments\/custom-made-hip-prosthesis\/\"><strong>hip replacement<\/strong><\/a><strong> may be indicated<\/strong>.<\/p>\n<p>In such situations, priority should be given to:<\/p>\n<ul>\n<li>a <strong>muscle-sparing surgical technique<\/strong> (direct anterior approach)<\/li>\n<li><strong>three-dimensional CT-based planning<\/strong>, essential for precise analysis of coxofemoral morphology<\/li>\n<\/ul>\n<p>When implanting a prosthesis for coxopathy with normal radiographs, it is crucial <strong>not to alter joint anatomy<\/strong>, using accurate planning, rigorous surgical technique, and, whenever possible, a <strong>custom-made implant<\/strong>.<\/p>\n<h2>Outcomes and limitations of prosthetic implantation<\/h2>\n<p>When severe, extensive chondropathy is present and consistent with the pain presentation, total hip replacement yields <strong>excellent results<\/strong>, allowing full return to unrestricted activities.<\/p>\n<p>Conversely, when the radioclinical picture lacks coherence\u2014atypical, diffuse pain associated with only mild chondropathy and no objective signs of joint suffering\u2014the prognosis is uncertain and the risk of <strong>diagnostic error<\/strong> is significant.<\/p>\n<p>In such cases, a <strong>preoperative anesthetic test<\/strong> is recommended to guide the decision toward either prosthetic implantation or surgical abstention.<\/p>\n<p><strong>Surgical abstention can sometimes be the most appropriate and beneficial decision.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The most common procedure in hip surgery is primary total hip replacement for advanced hip osteoarthritis. In typical cases, the surgical indication is straightforward when a patient presents with progressive coxofemoral pain resistant to medical treatment, associated with joint stiffness and radiographic signs of joint degeneration. When radiographs show advanced osteoarthritis or significant femoral head necrosis, proposing prosthetic implantation is logical.<\/p>\n","protected":false},"author":35,"featured_media":5060,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67],"tags":[],"class_list":["post-5057","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hip-surgery"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Implanting a hip prosthesis in coxopathy with normal radiographs | Paris and Lyon | Inside the Hip<\/title>\n<meta name=\"description\" content=\"The most common procedure in hip surgery is primary total hip replacement for advanced hip osteoarthritis. 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