Useful signs and symptoms for diagnosing hip osteoarthritis

Référence

Metcalfe D, Perry DC, Claireaux HA, Simel DL, Zogg CK, Costa ML. Does this patient have hip osteoarthritis? The rational clinical examination systematic review. JAMA 2019;322(23):2323-2333.

Sommaire

In the absence of a more reliable gold standard of diagnosis, these investigators wished to evaluate the accuracy of clinical findings in determining the prevalence of radiographic OA among adults presenting with hip pain 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 pain or groin pain. Studies were assessed for risk of bias using a standard scoring tool, and only level 1 and 2 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 - 3.6), a personal history of knee OA (LR+ = 2.1; 1.1 - 3.8), pain on climbing stairs or walking down slopes (LR+ = 2.1; 1.6 - 2.8), and the worst pain located in the medial thigh (LR+ = 7.8; 1.7 - 37). Findings associated with the absence of OA included: being younger than 60 years (negative likelihood ratio [LR-] = 0.11; 0.01 - 0.78), morning stiffness lasting less than 60 minutes (LR- range, 0.22 - 0.65), the absence of pain on walking (LR- range, 0.25 - 0.58), and the absence of pain improved by sitting (LR- = 0.24; 0.06 - 0.92). Physical findings associated with OA included: posterior hip pain caused by squatting (LR+ = 6.1; 1.3 - 29), groin pain on hip abduction or adduction (LR+ = 5.7; 1.6 - 20), abductor weakness (LR+ = 4.5; 2.4 - 8.4), decreased hip adduction (LR+ = 4.2; 3.0 - 6.0), and decreased internal rotation (LR+ = 3.2; 1.7 - 6.0). The absence of the following were useful in excluding OA: normal hip passive adduction (LR- = 0.25; 0.11 - 0.54) or abduction (LR- = 0.26; 0.09 - 0.77).