Hip Pain Decision Making: Role of Bone Scan

Here is the one of the hip xrays from my patient Albert. Albert has degenerative changes (wear and tear) on both hips, right greater than left. This is a standing AP Pelvic Xray with shoes on showing a short right leg that I am using lifts to level. Albert has had 6 synthetic cartilage injections into both hips, with the left hip doing great and the right hip still in pain. What complicates matters and the decision making for hip replacement is that he also problems with his right sacro-iliac joint and his right lumbar spine. Both areas can produce pain that can mimic hip pain and vice versa.

Here is a magnified image of Albert's right hip. The degenerative changes are mild to moderate only. Should he have a hip replacement was the question he asked me? I have seen Albert's function diminish over the last year and now he always has a cane in his left hand. But the xrays didn't look that bad!! His orthopedist was conservative, and really good at telling Albert that he would know when he needed a hip replacement. But was it just referred pain from the SI joint or low back? I encouraged him to get a bone scan for more definitive answers. He approached his orthopedist on the subject and the test was ordered.

Here is the Tc 99 bone scan images of Albert's hip area. I apologize that the image is turned around, but the side of the intense dye uptake is in the right hip. Bone scans document bone metabolism. Where is Albert trying to mend at the bone layer? The Tc 99 dye glues itself to the phosphorus molecules in your body. Phosphorus, calcium and water make up bone. After 2 hours of letting the dye circulate, the images are collected.

Here is a higher image on the body showing the dye in the kidneys already. You urinate the dye out of your body over 12 hours and patients are encouraged to drink alot the day of the test. The lumbar spine looks normal, but there is a slight increase in the right SI joint. But the dye accummulation in the right hip is so intense, Albert will be scheduling a hip replacement soon. Hopefully, we can get his short right leg corrected at the same time.