Does This Patient Have Hip Osteoarthritis?

Metcalfe, David; Perry, Daniel C.; Claireaux, Henry; Simel, David L.; Zogg, Cheryl K.; Costa, Matthew L.

doi:10.1001/jama.2019.19413

Cited by 37 publications

(29 citation statements)

References 28 publications

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“…A recent review provided detailed data on the utility of physical examination maneuvers in the diagnosis of hip OA and a video demonstration of the hip examination . Hip internal rotation of less than 15° is moderately sensitive (66%) and specific (72%), as is limited hip adduction (80% sensitive, 81% specific) . Pain with hip internal rotation is more sensitive (82%) but less specific (39%).…”

Section: Assessment and Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of Hip and Knee Osteoarthritis

Katz

Arant

Loeser

2021

JAMA

1,215

760

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ong characterized as a wear-and-tear disorder, osteoarthritis (OA) is now understood to have a complex pathophysiology affecting multiple joints and joint structures, as captured by the Osteoarthritis Research Society International definition of OA: "The disease manifests first as a molecular derangement (abnormal joint tissue metabolism) followed by anatomic, and/or physiologic derangements (characterized by cartilage degradation, bone remodeling, osteophyte formation, joint inflammation and loss of normal joint function), that can culminate in illness." 1 Worldwide, an estimated more than 240 million persons have symptomatic, activity-limiting OA, including an estimated more than 32 million in the US. 2,3 The knee and hip are 2 commonly affected joints and are the focus of this Review. Nearly 30% of individuals older than 45 years have radiographic evidence of knee OA, about half of whom have knee symptoms. 4,5 The prevalence of symptomatic, radiographic hip OA is around 10%. 6,7 The lifetime risk of symptomatic knee OA is greater in obese persons (body mass index Ն30) than in nonobese persons (19.7% vs 10.9%). 8 Prior joint trauma, such as anterior cruciate ligament rupture and ankle fracture, increases risk, accounting for 12% of knee OA cases. 9 The prevalence of symptomatic, radiographic knee OA was 11.4% in women and 6.8% in men in one large cohort study 4 and 18.7% in women and 13.5% in men in another large cohort study. 5 Compared with men with OA, women have more severe radiographic findings and symptoms. 10 Older age and female sex are risk factors for hip OA as well as knee OA. In addition, congenital and acquired anatomic abnormalities (eg, hip dysplasia) are risk factors for hip OA. Regarding race, African American and White persons have similar prevalence of hip OA (accounting for race, sex, and body mass index), while African American individuals, especially women, have higher prevalence of knee OA. 5,7 Osteoarthritis leads to substantial cost and mortality. Fortythree percent of the 54 million individuals in the US living with IMPORTANCE Osteoarthritis (OA) is the most common joint disease, affecting an estimated more than 240 million people worldwide, including an estimated more than 32 million in the US. Osteoarthritis is the most frequent reason for activity limitation in adults. This Review focuses on hip and knee OA.OBSERVATIONS Osteoarthritis can involve almost any joint but typically affects the hands, knees, hips, and feet. It is characterized by pathologic changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of valued activities, such as walking for exercise and dancing. Risk factors include age (33% of individuals older than 75 years have symptomatic and radiographic knee OA), female sex, obesity, genetics, and major joint injury. Persons with OA have more comorbidities and are more sedentary than those without OA. The reduced physical activity leads to a 20% higher age-adj...

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Section: Assessment and Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of Hip and Knee Osteoarthritis

Katz

Arant

Loeser

2021

JAMA

1,215

760

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“…The hip pain and stiffness subsequently reduce patient mobility [ 3 ]. Chronic joint pain is also associated with central sensitization, which can lead to referred pain and even tenderness distant from the affected joint [ 4 ]. The lower limb distribution of the pain in hip joint osteoarthritis and spinal stenosis using body image maps showed very similar patterns, with only subtle differences [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Severe Atrophy of the Ipsilateral Psoas Muscle Associated with Hip Osteoarthritis and Spinal Stenosis—A Case Report

Lee

Kim

et al. 2021

Medicina

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Pathology of the lumbar spine and hip joint can commonly coexist in the elderly. Anterior and lateral leg pain as symptoms of hip osteoarthritis and spinal stenosis can closely resemble each other, with only subtle differences in both history and physical examinations. It is not easy to identify the origin of this kind of hip pain. The possibility of hip osteoarthritis should not be underestimated, as this could lead to an incorrect diagnosis and inappropriate spinal surgery. We report the case of a 54-year-old female with chronic right anterior and lateral leg pain who did not respond to repeated spinal blocks based on lumbar MRI, but in whom hip osteoarthritis was considered since severe atrophy of the ipsilateral psoas muscle was identified. We suggest that severe psoas muscle atrophy can be a clinical clue to identify hip osteoarthritis and is related to lower extremity pain, even if there is a coexisting lumbar spine pathology.

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“…Study authors were contacted for additional data or clarifications when appropriate. Quality and risk of bias assessments were independently undertaken by two authors (LC and DM) using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2)18 and Rational Clinical Examination19 tools with disagreements resolved through discussion. QUADAS-2 is a validated tool for evaluating the risk of bias and applicability of diagnostic accuracy studies using four domains: patient selection, index test, reference standard, and flow and timing 18.…”

Section: Methodsmentioning

confidence: 99%

Which clinical features best predict occult scaphoid fractures? A systematic review of diagnostic test accuracy studies

et al. 2023

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BackgroundPlain radiographs cannot identify all scaphoid fractures; thus ED patients with a clinical suspicion of scaphoid injury often undergo immobilisation despite normal imaging. This study determined (1) the prevalence of scaphoid fracture among patients with a clinical suspicion of scaphoid injury with normal radiographs and (2) whether clinical features can identify patients that do not require immobilisation and further imaging.MethodsThis systematic review of diagnostic test accuracy studies included all study designs that evaluated predictors of scaphoid fracture among patients with normal initial radiographs. Quality assessment was undertaken using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analyses included all studies.ResultsEight studies reported data on 1685 wrist injuries. The prevalence of scaphoid fracture despite normal radiographs was 9.0%. Most studies were at overall low risk of bias but two were at unclear risk; all eight were at low risk for applicability concerns. The most accurate clinical predictors of occult scaphoid fracture were pain when the examiner moved the wrist from a pronated to a supinated position against resistance (sensitivity 100%, specificity 97.9%, LR+ 45.0, 95% CI 6.5 to 312.5), supination strength <10% of contralateral side (sensitivity 84.6%, specificity 76.9%, LR+ 3.7, 95% CI 2.2 to 6.1), pain on ulnar deviation (sensitivity 55.2%, specificity 76.4%, LR+ 2.3, 95% CI 1.8 to 3.0) and pronation strength <10% of contralateral side (sensitivity 69.2%, specificity 64.6%, LR+ 2.0, 95% CI 1.2 to 3.2). Absence of anatomical snuffbox tenderness significantly reduced the likelihood of an occult scaphoid fracture (sensitivity 92.1%, specificity 48.4%, LR- 0.2, 95% CI 0.0 to 0.7).ConclusionNo single feature satisfactorily excludes an occult scaphoid fracture. Further work should explore whether a combination of clinical features, possibly in conjunction with injury characteristics (such as mechanism) and a normal initial radiograph might exclude fracture. Pain on supination against resistance would benefit from external validation.Trial registration numberCRD42021290224.

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Does This Patient Have Hip Osteoarthritis?

Abstract: Hip osteoarthritis (OA) is a common cause of pain and disability.OBJECTIVE To identify the clinical findings that are most strongly associated with hip OA.

Cited by 37 publications

References 28 publications

Diagnosis and Treatment of Hip and Knee Osteoarthritis

Diagnosis and Treatment of Hip and Knee Osteoarthritis

Severe Atrophy of the Ipsilateral Psoas Muscle Associated with Hip Osteoarthritis and Spinal Stenosis—A Case Report

Which clinical features best predict occult scaphoid fractures? A systematic review of diagnostic test accuracy studies

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