The hip joint is a synovial joint between the acetabulum of the pelvis and the head of the femur,
which connects the axial skeleton with the lower extremity.
Conventional radiography is widely used in the study of hip disease because of its availability,
reliability and low cost.
The most performed incidence is anteroposterior view (AP view).
Other radiographic projections (cross-table lateral,
Dunn,
frog-leg lateral and false-profile) are used when certain pathologies are suspected.
The anteroposterior pelvic and false-profile views provide information regarding acetabular morphology.
On the other hand,
frog-leg lateral and Dunn views highlight anatomy of the proximal part of the femur.
It is important to recognize parameters for plain radiographic assessment to ensure that patient positioning was appropriate and the reliability of radiographies to serve as diagnostic tool.
Radiographic views
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Anteroposterior pelvic view (unilateral or bilateral)
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Frog-leg lateral view
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45° or 90° Dunn view
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Cross-table lateral view
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False-profile view
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Anterior or posterior oblique view (Judet view)
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Anteroposterior Pelvic View
Indications: Routine,
fractures,
joint dislocations,
degenerative disease and bone lesions.
Evaluation Criteria
- Coccyx aligned with the pubic symphysis.
- Symmetrical iliac wings,
obturator ring and radiographic teardrops.
- Lesser trochanters should not be visible.
Fig. 1: Anteroposterior view of the pelvis
Fig. 2: AP Positioning
- Patient supine on the x-ray table.
- Both lower extremities oriented in 15° of medial rotation (to maximize the length of the femoral neck)
Frog-Leg Lateral View
Indications: non-trauma hip,
developmental dysplasia of hip,
slipped capital femoral epiphysis,
assessment of head-neck junction.
Evaluation Criteria
- Greater trochanter appears superimposed over the femoral neck,
which appear foreshortened.
Fig. 3: Frog-leg lateral view
Fig. 4: Frog-leg lateral view Positioning
- Patient supine on the x-ray table.
- Feet together (if bilateral), affected knee flexed (30-40º), thighs abducted (45º) and externally rotated.
45° or 90° Dunn View
Indications: Diagnosis of femoral-acetabular impingement (the prefered view to demonstrate femoral head-neck asphericity).
Evaluation Criteria
- Relationship between the acetabulum and femoral head well demonstrated.
- Anterior superior iliac spine and proximal shaft of femur included in image.
Fig. 5: Dunn view at 45º
Fig. 6: Dunn view at 45º Positioning:
- Patient supine on the x-ray table.
- Modified Dunn view uses 45º hip flexion, when 90º is not possible.
Fig. 7: Dunn view at 45º
Fig. 8: Dunn view at 90º Positioning
- Patient supine on the x-ray table.
- Pelvis in neutral rotation while symptomatic hip joint is flexed 90º and abducted 20º.
Cross-table Lateral View
Indications: expose the anterolateral surface of the femoral head-neck transition.
Evaluation Criteria
- Greater trochanter should not be seen to overhang posteriorly.
- Visible lesser trochanter indicates adequate internal rotation.
Fig. 9: Cross-table lateral view
References: 2015 by Korean Hip Society
Fig. 10: Cross-table lateral view Positioning
- Patient supine on the x-ray table.
- Contralateral hip and knee flexed beyond 80°.
- Symptomatic limb internally rotated 15°.
False-Profile View (Lequesne view)
Indications: assessment of femoroacetabular impingement (visibility of the medial and anterosuperior head coverage) and acetabular dysplasia.
Evaluation Criteria
- Distance between femoral heads should correspond to the diameter of a femoral head.
- Profile of head and proximal femur but not the acetabulum.
Fig. 11: False-Profile view
Fig. 12: False-Profile view Positioning
- Patient in orthostatic position.
- Affected hip against the cassette.
- Pelvis rotated 65°anteriorly in relation to the cassette
Anterior or Posterior oblique View (Judet view)
Indications: Visualization of the anterior or posterior margins of the acetabulum (evaluate acetabular fracture or pelvis injury).
Evaluation Criteria
· Downside:
- Posterior oblique position demonstrates the posterior column (ilioischial) and anterior acetabular rim.
· Upside:
- Anterior oblique position demostrates the anterior column (iliopubic) and posterior acetabular rim.
The obturador foramen is also visualized.
- Proper degree of obliquity is shown as an open and uniform hip joint space at the rim of acetabulum and femoral head.
Fig. 13: Judet view. Right posterior oblique (downside)
References: 2015 by Korean Hip Society
Fig. 14: Image 13: Judet view Positioning
- Patient in a 45° oblique position.
- Centered on the downside (affected side down.
- Centered on the upside (affected side up).
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