EP5.1 Preoperative MRI Poorly Predicts Intraoperative Findings During Hip Arthroscopy

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ID: 331226
2026
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Abstract
Abstract Introduction The clinical utility of MRI prior to hip arthroscopy is unclear. Our objective was to assess the interobserver reliability of MRI interpretation among hip surgeons and assess its diagnostic agreement with intraoperative findings in patients undergoing hip arthroscopy. Methods We included 24 consecutive patients enrolled in a randomized controlled trial (RCT) undergoing hip arthroscopy in conjunction with periacetabular osteotomy (PAO). Seven fellowship-trained hip surgeons reviewed clinical histories, plain film radiographs, and MRI scans. Surgeons were asked to determine if hip arthroscopy was indicated for central compartment disease. Following a six-week washout period, the same seven surgeons repeated the analysis supplemented with standardized MRI reports from a fellowship-trained musculoskeletal (MSK) radiologist. Surgeons' indications were compared with the ‘gold-standard’ intraoperative procedure performed (labral debridement, repair, or reconstruction). Reliability and agreement with the surgical procedure performed were assessed with Cohen’s Kappa and changes in Kappa were compared with and without the radiology report using the approximate z test. Kappa <0.00 suggests poor reliability, 0.00-0.20 slight, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 substantial, and 0.81-1.00 almost perfect agreement. Results Diagnostic agreement between MRI-based indications and intraoperative findings was poor, with a percentage agreement of 38% (kappa=0.034) when surgeons had access to standardized radiology reports and 32% (kappa=-0.009) without reports (p=0.42). The addition of radiology reports did not significantly improve interobserver reliability, with kappa values of 0.065 and 0.124 with and without reports, respectively (p=0.47). Intraobserver reliability across sessions was 79% (kappa=0.439). Conclusion Preoperative MRI is a poor predictor of the need for central compartment work during hip arthroscopy. Our results suggest that routine preoperative MRI may have limited clinical utility in this patient population.
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Authors Paul Beaulé, Emmitt Hayes, Ariane Parisien
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.353
URL
https://doi.org/10.1093/jhps/hnag043.353
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