Clinical–Radiographic Dissociation in Early Hip Osteoarthritis in Postmenopausal Women

Background: Pain is often the main trigger for the diagnosis of hip osteoarthritis (OA), typically confirmed by radiographic findings such as joint space narrowing and subchondral sclerosis. However, a small subset of postmenopausal women experience severe hip pain despite minimal changes on radiographs and magnetic resonance imaging (MRI), leading to diagnostic uncertainty and potential treatment delays.

Objective: To describe a series of postmenopausal women with severe hip pain but minimal radiographic findings who underwent total hip arthroplasty (THA), and to report their clinical outcomes.

Methods: We retrospectively reviewed data from 32 patients (mean age: 54 years) with a minimum follow-up of one year. Radiographs and MRI were used to identify patients with Kellgren-Lawrence grade <2 and no clear lesions on MRI. All patients underwent uncemented total hip arthroplasty via an anterolateral approach following a standardized rehabilitation protocol. Clinical outcomes were assessed using the Harris Hip Score (HHS) and WOMAC, both preoperatively and one year after surgery.

Results: Despite limited imaging evidence of OA, intraoperative findings revealed significant cartilage damage. At one-year follow-up, the HHS improved from 48 ± 4.2 to 96 ± 3.8 (p < 0.001), and the WOMAC score decreased from 63.2 ± 5.5 to 22.5 ± 4.7 (p < 0.001). Patients reported rapid pain relief and returned to their usual activities within an average of 45 days postoperatively.

Conclusions: Total hip arthroplasty provides effective pain relief and functional improvement in postmenopausal women with severe hip pain but minimal findings on radiographs or MRI. These results highlight the importance of clinical judgment when imaging studies do not clearly explain the patient’s symptomatic presentation.

Keywords: Hip Osteoarthritis, Clinical–Radiographic Dissociation.

Level of Evidence IV: Case series