Hip Arthritis X-Ray Not Associated with Pain?

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hip arthritis x-ray

I love studies that question our belief systems in orthopedics, and this new one is a doozy. Several years ago, orthopedic guidelines shifted from requiring a knee or hip MRI to recommend a knee or hip replacement to just requiring X-rays. Now, a new study questions whether that’s a smart idea. Basically, it didn’t find an association between a positive hip arthritis X-ray and hip pain.

Arthritis and Imaging

Many studies I’ve covered over the years also show that MRI findings simply aren’t a very accurate predictor of hip or knee pain. Most physicians, for example, who see a hole in the cartilage on MRI in a patient with knee pain would automatically associate the two. However, one study showed that patients with a hole in their knee cartilage didn’t have any greater chance of having pain as those without a hole in their cartilage.

Lumbar stenosis is another MRI finding that many doctors will find significant when a patient has hip pain. If an MRI shows compressed nerves due to arthritis (stenosis), then the patient must have pain. Yet a recent study concluded no relationship between the finding of spinal stenosis on MRI and pain. Another study found MRI worthless in diagnosing spinal stenosis as the cause of pain.

Hip arthroscopies are also being done for tears of the labrum and hip impingement found on MRI and associated with the patient’s hip pain. Here again, the MRI is an inaccurate indicator for diagnosing the cause of hip pain as many patients with no pain can show signs of tears and impingement on their MRI. And many patients who undergo surgery for these conditions due to their pain still complain of hip pain.

Another common surgery we see being done based no MRI findings is meniscus-tear repair. If you are a regular reader of this blog, you know how opposed I am to most meniscus surgery. Meniscus tears seen on MRI are no more significant than wrinkles or gray hair. Many of us develop them as we age, and just as many people who don’t have knee pain have meniscus tears. So meniscus tears on MRI plus knee pain should not result in knee surgery.

This lack of association between knee pain and MRI findings is nothing new. I’ve been sharing these knee surgery and MRI studies with you since way back in 2008, when the New England Journal published a study showing 60% of people with meniscus tears present on MRI did not actually have any knee pain.

So if MRIs already weren’t cutting it, why are we now diagnosing pain with nothing more than a simple X-ray?

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Today’s Common Practice of a Hip Arthritis X-Ray and Then Surgery

If a patient walks in with a hip X-ray that shows moderate hip arthritis and reports hip pain, you can bet that after a cursory exam (usually performed by a physician extender), it’s time to replace the hip. Ten years ago, these decisions were made using MRIs, but some government committee decided at some point that all that was needed was a hip arthritis X-ray. Is this a good idea? Not according to a recent study.

The New Research on Hip X-Rays and Pain

This new study used data from the Framingham osteoarthritis study, a government-funded investigation into the nature of imaging and arthritis. Looking at 946 patient X-rays of hips, only 15.6% of the patients with frequent hip pain showed evidence of hip arthritis. In addition, only 20.7% of the hips with hip arthritis were frequently painful. In a much larger Osteoarthritis Initiative study (n=4,366), only 9.1% of hips in patients with frequent pain showed evidence of hip arthritis, and only 23.8% of hips with hip arthritis on X-ray were frequently painful. The authors concluded, “Hip pain was not present in many hips with radiographic osteoarthritis, and many hips with pain did not show radiographic hip osteoarthritis.”

The upshot? At the end of the day, this study doesn’t support the idea that we should be using a hip arthritis X-ray and the presence of hip pain as the major determinant of which hips need replacing. It’s consistent with many other studies showing that arthritis on X-ray or MRI and pain are two different things. Now we just need to reeducate an army of orthopedic surgeons who are likely amputating hips that don’t hurt that they need to look more closely at this issue. How can you prevent this from happening to you? Make sure you get a numbing shot in your hip under X-ray guidance and that this resolves your pain before you have someone replace your hip. Better yet, make sure you see if you’re a candidate for stem cells in that hip before someone cuts it off!

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11 thoughts on “Hip Arthritis X-Ray Not Associated with Pain?

  1. Rick Moss

    Brilliant analysis I would highly recommend people take more care and look into things deeply before letting Surgeons want to take away your hip , after two of my friends just had double hip replacements , I am even more convinced that it will not happen to me, one had the Recall ones and has been on Pain Meds since he had them done and has to have them done again, the other is suffering from Back pain and also is worried about his future.
    I will work towards the Stem Cells I have done my homework and attended your classes , I believe it will work and worth trying I will keep you posted onv=ce I set that up.

    1. Regenexx Team Post author

      Looking forward to helping you keep all your original parts!

  2. Lisa Kruczek

    I think this thought process should extend into other areas of the body. I have experienced pain in my shoulders and told it was arthritis based on x-rays and MRIs. It was all hogwash. Doctors are still PRACTICING Medicine. Seven surgeries to fix the shoulders was futile. A piece of bone from the head of the humorous found during a surgery prompted a partial shoulder replacement. Nothing took care of the pain. I asked what causes the cartilage to disintegrate and all the pain. The doctor said that was between me and God. When the second shoulder did the exact same thing he said he had never seen this in someone my age. I am 50 years young. I told my family doctor what the specialist said. She ordered a special test. It appears to be osteonecrosis.

    1. Regenexx Team Post author

      So sorry to hear of your ordeal! Unfortunately, it exemplifies the huge problems of the current paradigm of structural orthopedics. Finding the actual source of pain, and treating that regeneratively with injections of patient’s own stem cells and platelets is what we do in all areas of the body. This explains what Osteonecrosis is, and what we can do about it: https://regenexx.com/avoid-osteonecrosis-surgery-stem-cell-injections/

  3. Paul C. Constant, Jr.

    I’m confused. I have cardioarthridis in my right hip as determined by X-rays. I generally have severe pains after sitting for a time, The pains are quite stronger upon and after rising until I hobble along using a walker. These pains are in the hip are and in the groin nuscle. I have pain in my arthritic hi leg when I walk. At night I frequently have excruciating pain inmy arthritic hip leg from the hip to and including the ankle with the major portion of the pain in the knee and extending downward. The apparant solution I found was strong and continuing rubbing of all painful areas for times that vary from i5 to 45 ninutes. Some nights these events occur as m any as 7 times, but the events are usualu limited to 2 or 3. I have had cortoon shots in the hip that have helped, the the improvment gaained deminishes in time. I Iam told by a specist cell doctor that my cells are not suffficiently viable to have a stem-cell opporation. (I am 94.) Is there some other means to solve my problem, i.e., by a cokctail the engredients of which are derived from ordinary food products, such as blueberries, that would regenerate, as ones’ body does naturally, the required cells so that I would not need an operation?

    1. Regenexx Team Post author

      Paul C.Constant, Jr.
      Sounds like you’re doing great for 94! We’re not saying that people who have arthritis on a hip Xray don’t have arthritis, just that there is often a different reason for the pain so proceeding with a hip replacement with just an Xray doesn’t make sense, or serve the patient. Steroid shots often give temporary relief, but escalate the problem in the long run, as they are lethal to the local stem cells, break down cartilage and damage tendons: https://regenexx.com/steroid-injection-risks/. Adding in supplements that support joint health instead can help move things in the right direction by helping inflammation, pain, and supporting cartilage. You’ll find these here: https://regenexx.com/regenexx-advanced-stem-cell-support-formula/ But while they can help, there isn’t a substitute for finding out what’s going on. A Regenexx Hip exam involves examining your lower back (where much hip and knee pain actually originate), your hip, knee and ankle: https://regenexx.com/hip-replacement-back-pain/ Once we know what’s causing what, we can see what can be done to make you more comfortable. My Mom was awakened many times every night for 2 years with toe cramps until we treated her low back: https://regenexx.com/blog/toe-cramps-back-pain/. You’re not too old for treatment as we acommodate for age – no operations involved, just injections. We might find we can do nothing, but more than likely we’ll find we can do something to help you spend these golden years in less pain. Here is the Interactive list of Regenexx providers:https://regenexx.com/find-a-physician/

  4. Lisanne Garvin

    It still amazes me so many doctors just want to hack parts of you off! What about the fact that you’re still using those parts don’t they care about that? no I don’t believe they do. I refuse to let them do any of that Dark Age medicine on me! I know people that have had six shoulder surgeries or four back and neck surgeries- with more and more pain! Keep up the good work I hope to have treatment for my hip and elbows one day when I can afford it.

  5. Dori

    I am so glad I found Regenexx. I’ve been to a couple of webinars and got some very good insights. The newsletters have helped, too. I don’t want any part of my body hacked off, God put all the parts there for a reason. I have some hip pain which has limited by range of motion and yes, the doctors suggest hip replacement and I’ll be fine. I understand that there are people who rave about their “new hip” but there are too many potential issues to consider and the prospect of long-range health is a big one, imo. So I am saving money toward my treatment at Regenexx. :-)

    1. Regenexx Team Post author

      Very wise for doing all you can to keep all your body parts, as “replacement” is not an accurate description. We look forward to helping you do that.

  6. Mariann Fogarty

    I have severe hip pain in both hips and back pain. My right hip is really bad. I walk with a cane. I have pain at night. I can’t put on my clothes without help. Does insurance cover these treatments?

    1. Regenexx Team Post author


      Unfortunately, no type of insurance covers stem cell treatment yet. But importantly, your hip issues might orginate from your back. Please see:https://regenexx.com/hip-replacement-back-pain/

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