Focused examination for hip osteoarthritis including functional assessment, severity grading, and differentiation from other causes of hip pain.
Hip OA examination combines functional assessment with joint-specific testing. Examiners expect you to assess gait (Trendelenburg), measure ROM accurately, recognize the pattern of restriction (capsular pattern: IR > extension > abduction > flexion), and correlate findings with severity and functional impact.
High-Yield Exam Summary
Pain Pattern:
Stiffness:
Functional Impact:
Antalgic Gait:
Trendelenburg Gait:
Compensated Trendelenburg:
Combined Pattern:
Hip abductor function
Pelvis drops on the unsupported (swing) side
Hip abductor weakness (gluteus medius dysfunction) - OA, post-THR, L5 weakness, DDH
Ability to detect true positives
Ability to exclude false positives
Capsular Pattern (OA): Internal rotation > Extension > Abduction > Flexion
This means IR is lost first and most severely, while flexion is preserved longest.
Normal Values:
Testing Position:
Fixed flexion deformity assessment
Affected hip cannot rest flat on bed (flexion deformity)
Fixed flexion deformity - measure angle between thigh and bed. FFD indicates hip OA, capsular contracture
Ability to detect true positives
Ability to exclude false positives
Fixed Flexion Deformity (FFD):
True vs Apparent:
Causes of LLD in Hip OA:
Galeazzi Test (Bryant Test):
Functional hip assessment
Difficulty rising, using arms to push up, trunk lean
Hip weakness, pain, or stiffness
Ability to detect true positives
Ability to exclude false positives
Functional mobility
Slow walking speed (under 1 m/s suggests significant impairment)
Functional limitation - correlates with surgical outcomes
Ability to detect true positives
Ability to exclude false positives
Functional hip ROM assessment
Unable to reach foot, needs assistance or devices
Significant hip stiffness affecting daily function
Ability to detect true positives
Ability to exclude false positives
| severity | pain | rom | function | xray |
|---|---|---|---|---|
| Mild | Activity-related, walking unlimited | Mild restriction (IR mainly) | Minor limitation | Joint space greater than 2mm |
| Moderate | After shorter walks, some rest pain | Moderate restriction, developing FFD | Significant limitation | Joint space 1-2mm |
| Severe | Night pain, rest pain, very limited walking | Severe restriction, FFD greater than 15° | Major ADL impairment | Bone on bone |
| condition | painLocation | rom | specialFeatures |
|---|---|---|---|
| Hip OA | Groin, anterior thigh | Capsular pattern | Mechanical pain, morning stiffness under 30 min |
| Lumbar Spine | Back to buttock, below knee | Hip ROM normal | Neurological signs, SLR positive |
| Trochanteric Bursitis | Lateral hip | Normal (may resist abduction) | Point tenderness over GT |
| AVN | Groin (severe) | May be normal early | Risk factors, night pain early |
| Inflammatory Arthritis | Groin | Polyarticular often | Morning stiffness greater than 30 min, systemic features |
| FAI | Groin | IR limited, others preserved | Young patient, FADIR positive |
| Grade | Findings |
|---|---|
| 0 | Normal |
| 1 | Doubtful: possible osteophytic lipping |
| 2 | Minimal: definite osteophytes, possible JSN |
| 3 | Moderate: Moderate JSN, some sclerosis, cyst formation |
| 4 | Severe: Large osteophytes, marked JSN, severe sclerosis, bone deformity |
Note: Clinical severity may not correlate with radiographic severity
Document for THR planning:
"68-year-old woman with 3-year history of progressively worsening right hip pain. Now using a walking stick and can only walk 100 meters."
Harris Hip Score (HHS):
Oxford Hip Score (OHS):
WOMAC:
High-Yield Exam Summary