Clinical Question

What clinical signs and symptoms are useful for diagnosing radiography-based hip osteoarthritis (OA) in adults?

Bottom Line

Although plain radiographs are often used to diagnose hip OA, the correlation between radiographic indicators of hip arthritis and hip pain is low. The accuracy of clinical symptoms and signs for diagnosing hip OA in this study is based on radiography as the diagnostic standard. (Level of Evidence = 4)

Synopsis

In the absence of a more reliable diagnostic standard, the investigators wished to evaluate the accuracy of clinical findings in determining the prevalence of radiographic OA among adults presenting with hip or groin pain. Two individuals independently searched multiple databases, including PubMed, MEDLINE, and CINAHL, as well as reference lists of previous review articles for studies describing clinical findings in patients with hip or groin pain. Studies were assessed for risk of bias using a standard scoring tool, and only level one and two studies (N = 6, reporting data from 110 patients) were included. Discrepancies were resolved by consensus agreement with a third reviewer.

Clinical findings associated with the presence of hip OA included a family history of OA (positive likelihood ratio [LR+] = 2.1; 1.2 to 3.6), a personal history of knee OA (LR+ = 2.1; 1.1 to 3.8), pain when climbing stairs or walking down slopes (LR+ = 2.1; 1.6 to 2.8), and the worst pain located in the medial thigh (LR+ = 7.8; 1.7 to 37). Findings associated with the absence of OA included being younger than 60 (negative likelihood ratio [LR−] = 0.11; 0.01 to 0.78), morning stiffness lasting less than 60 minutes (LR− range, 0.22 to 0.65), the absence of pain on walking (LR− range, 0.25 to 0.58), and the absence of pain improved by sitting (LR− = 0.24; 0.06 to 0.92). Physical findings associated with OA included posterior hip pain caused by squatting (LR+ = 6.1; 1.3 to 29), groin pain on hip abduction or adduction (LR+ = 5.7; 1.6 to 20), abductor weakness (LR+ = 4.5; 2.4 to 8.4), decreased hip adduction (LR+ = 4.2; 3.0 to 6.0), and decreased internal rotation (LR+ = 3.2; 1.7 to 6.0). The absence of normal hip passive adduction (LR− = 0.25; 0.11 to 0.54) or abduction (LR− = 0.26; 0.09 to 0.77) was useful in excluding OA.

Study design: Systematic review

Funding source: Foundation

Setting: Various (meta-analysis)

Reference: Metcalfe D, Perry DC, Claireaux HA, et al. Does this patient have hip osteoarthritis?: the rational clinical examination systematic review. JAMA. 2019;322(23):2323–2333.