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Ultrasound signs of hip disease

Medical expert of the article

Oncologist, radiologist
, medical expert
Last reviewed: 06.07.2025

The main task of the ultrasound doctor is to conduct differential diagnostics between intra-articular and extra-articular pathology. Intra-articular pathological conditions include: effusion into the joint cavity, synovitis, deforming arthrosis, aseptic necrosis of the femoral head.

Joint effusion, synovitis.

The presence of effusion in the hip joint is diagnosed by ultrasound if the distance between the surface of the femoral neck and the joint capsule exceeds 9-10 mm. With synovitis, as a rule, thickening of the joint capsule is observed. Therefore, it is important to evaluate the symmetry of the thickness of the joint capsule with the healthy side. A difference of more than 1-2 mm indicates pathology of the synovial joint bag. Ultrasound is also used to detect fluid around a prosthetic hip joint or after osteosynthesis. With CT or MRI, metal prostheses often cause artifacts that interfere with the correct assessment of the presence of fluid in the cavity or around the joint.

Osteochondromatosis and "joint mouse".

Foreign fragments may appear in the synovial joint capsule during fractures, ruptures of bone or cartilage structures, osteoarthritis, osteochondromatosis. Fragments enter the joint space, forming a "joint mouse". A joint mouse in ultrasound is, as a rule, an intra-articular mobile hyperechoic structure.

Ununited fractures and pseudoarthroses.

All factors leading to slow fusion of fragments, if the necessary measures are not taken, can lead to the formation of pseudoarthroses. Pseudoarthroses are observed after osteosynthesis of closed fractures of the femoral shaft, if the operation was complicated by suppuration, osteomyelitis. During ultrasound examination, pseudoarthroses can be detected by the presence of: discontinuity of bone contours and unevenness of bone callus with a defect; distal acoustic shadow behind bone structures at the site of pseudoarthroses. As a rule, there is a zone of perifocal inflammation with a pronounced vascular reaction around.

Aseptic necrosis of the femoral head.

The disease is a severe pathology of the hip joint, which mainly affects men, is long-term and leads to a persistent decrease in working capacity and disability. It often manifests itself as a complication after any hip joint injury (dislocation, bruise), in the vast majority of cases it occurs after a fracture of the femoral neck.

Clinically, in the early stages, it manifests itself as joint pain, atrophy of the thigh and lower leg muscles, limited joint movement, and gait disturbance. Ultrasound examination does not reveal any significant changes in the early stages. Sometimes, reactive effusion in the joint cavity can be detected. Later, the symmetry of the hip joint contours is disrupted. The joint space narrows. The contours of the femoral head become uneven.

Due to constant trauma, the joint capsule thickens and synovitis is observed.

Hip replacement. Ultrasound examination helps to identify early and late postoperative complications in hip replacement, such as infection, hematoma and intra-articular effusion. After metal replacement, the ultrasound method becomes the only most sensitive of all radiation methods for identifying soft tissue pathology and effusion in the joint cavity.


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