import { HighYieldBox, ExamCheatSheet, Tabs, Tab, ComparisonTable, VivaScenario, ContentSection, SpecialTestCard , MedicalImage} from '@/components/content' # Hip Osteoarthritis Assessment 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. ## Quick Reference One-Pager ## Clinical Presentation **Pain Pattern:** - Groin pain (commonest site) - May radiate to anterior thigh, knee (referred) - Lateral hip (if associated trochanteric bursitis) - Mechanical: worse with activity, better with rest - Start-up pain (stiffness on rising) - Night pain indicates severe disease **Stiffness:** - Morning stiffness less than 30 minutes (OA pattern) - Greater than 30 minutes suggests inflammatory arthritis - Improving with movement **Functional Impact:** - Walking distance reducing - Stairs difficult (especially descending) - Difficulty with socks/shoes - Getting in/out of car - Sexual function may be affected ## Gait Assessment **Antalgic Gait:** - Short stance phase on affected side - Patient "gets off" the painful hip quickly - Indicates pain as primary driver **Trendelenburg Gait:** - Pelvis drops on swing (unaffected) side - Indicates abductor weakness (gluteus medius) - May be due to pain inhibition or muscle wasting **Compensated Trendelenburg:** - Trunk shifts OVER affected hip - Moves center of mass over hip - Reduces force required from abductors **Combined Pattern:** - Most hip OA patients have both antalgic and Trendelenburg components - The combined pattern is diagnostic of hip pathology ## Range of Motion Assessment **Capsular Pattern (OA):** Internal rotation > Extension > Abduction > Flexion This means IR is lost first and most severely, while flexion is preserved longest. **Normal Values:** - Flexion: 120-130° - Extension: 10-15° (beyond neutral) - Abduction: 45-50° - Adduction: 20-30° - Internal rotation: 35-45° - External rotation: 45-50° **Testing Position:** - Flexion: Supine, stabilize pelvis - Extension: Thomas test (supine) or prone - Abduction: Supine, stabilize pelvis - Rotation: Supine with hip flexed 90° or with hip extended **Fixed Flexion Deformity (FFD):** - Develops as OA progresses - Compensated by lumbar hyperlordosis when standing - Causes increased energy expenditure in gait - Contributes to apparent leg length discrepancy - Target for surgical correction in THR ## Leg Length Assessment **True vs Apparent:** - **True LLD**: Measure ASIS to medial malleolus (bony length) - **Apparent LLD**: Measure umbilicus/xiphisternum to medial malleolus (functional) - Apparent greater than true = adduction deformity or pelvic obliquity **Causes of LLD in Hip OA:** - True shortening: Superior migration of femoral head, femoral head collapse (AVN, OA) - Apparent shortening: Fixed adduction deformity - Apparent lengthening: Fixed abduction deformity **Galeazzi Test (Bryant Test):** - Patient supine, hips and knees flexed, feet flat on bed - Observe knee heights - Unequal knee height indicates tibia or femur discrepancy ## Functional Tests ## Severity Assessment ## Differential Diagnosis ## Imaging Correlation | 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 ## Preoperative Assessment for THR **Document for THR planning:** - Walking distance (how far before stopping) - Night pain, rest pain - Analgesic use (type, frequency) - Failed conservative treatments - ROM restrictions (especially FFD) - Leg length discrepancy - Trendelenburg status - Medical fitness (ASA grade) - Patient expectations ## Summary Presentation Extension > Abduction > Flexion", "Thomas test quantifies fixed flexion deformity", "Document walking distance and functional limitation", "Trendelenburg indicates abductor dysfunction" ]} traps={[ "Not checking lumbar spine as cause of groin/thigh pain", "Forgetting to measure true vs apparent leg length", "Missing FFD by not doing Thomas test properly", "Not documenting functional impact (walking distance, ADLs)" ]} /> ## Outcome Measures **Harris Hip Score (HHS):** - Maximum 100 points - Pain (44), Function (47), ROM (5), Deformity (4) - Under 70 poor, 70-79 fair, 80-89 good, 90-100 excellent **Oxford Hip Score (OHS):** - 12 questions, patient-completed - Scores 0-48 (higher = better) - Widely used in registries (AOANJRR) **WOMAC:** - 24 questions: Pain (5), Stiffness (2), Function (17) - Validated for hip and knee OA ## Examiner Tips