Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis

Abstract

BackgroundHip Physical Examination (HPE) tests have long been used to diagnose a myriad of intra-and extra-articular pathologies of the hip joint. Useful clinical utility is necessary to support diagnostic imaging and subsequent surgical decision making.ObjectiveSummarise and evaluate the current research and utility on the diagnostic accuracy of HPE tests for the hip joint germane to sports related injuries and pathology.MethodsA computer-assisted literature search of MEDLINE, CINHAL and EMBASE databases (January 1966 to January 2012) using keywords related to diagnostic accuracy of the hip joint. This systematic review with meta-analysis utilised thePreferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guidelines for the search and reporting phases of the study. Der-Simonian and Laird random effects models were used to summarise sensitivities (SN), specificities (SP), likelihood ratios and diagnostic OR.ResultsThe employed search strategy revealed 25 potential articles, with 10 demonstrating high quality. Fourteen articles qualified for meta-analysis. The meta-analysis demonstrated that most tests possess weak diagnostic properties with the exception of the patellar-pubic percussion test, which had excellent pooled SN 95 (95% CI 92 to 97%) and good specificity 86 (95% CI 78 to 92%).ConclusionSeveral studies have investigated pathology in the hip. Few of the current studies are of substantial quality to dictate clinical decision-making. Currently, only the patellar-pubic percussion test is supported by the data as a stand-alone HPE test. Further studies involving high quality designs are needed to fully assess the value of HPE tests for patients with intra- and extra-articular hip dysfunction.

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

“…64,65 A recent systematic review and meta-analysis by Reiman et al deemed 4 clinical tests to be both valid and reliable for the diagnosis of gluteal tendinopathy: Trendelenburg sign, resisted hip abduction, resisted hip internal rotation, and the resisted hip external derotation tests (Video 2). 66 The most clinically reliable test was the external derotation test, with a specificity of 97.3%, sensitivity of 88%, positive likelihood of 32.6, and negative likelihood of 0.12. 66 In a retrospective review of the US examinations of 877 patients with greater trochanteric pain syndrome, Long et al found that 50% had tendinosis of the gluteal tendons, 28.5% had a thickened iliotibial band, 20% had trochanteric bursitis, and only 0.5% had gluteal tendon tears.…”

“…66 The most clinically reliable test was the external derotation test, with a specificity of 97.3%, sensitivity of 88%, positive likelihood of 32.6, and negative likelihood of 0.12. 66 In a retrospective review of the US examinations of 877 patients with greater trochanteric pain syndrome, Long et al found that 50% had tendinosis of the gluteal tendons, 28.5% had a thickened iliotibial band, 20% had trochanteric bursitis, and only 0.5% had gluteal tendon tears. 61 Gluteal tendinosis is diagnosed with US as a thickened tendon with loss of the normal fibrillar tendon architecture with or without superimposed calcifications.…”

“…Only the Trendelenburg sign was found to have clinically applicable diagnostic accuracy, with a sensitivity of 55%, specificity of 70%, positive likelihood ratio of 1.83, and negative likelihood ratio of 0.82. 66 Radiography may demonstrate narrowing of the superior and medial joint space, superior and inferior acetabular and femoral osteophytes, and subchondral cysts. 72 Superolateral subluxation of the femoral head may also be present.…”

“…76,77 Several history and physical examination tests have been developed to aid in the diagnosis of FAI and related intra-articular pathology. 66,78,79 Recent meta-analyses have identified that the flexionadduction-internal rotation test and the flexion internal rotation test have high sensitivity (N90%) for the diagnosis of hip impingement and intra-articular pathology, including labral tear. 66,79 However, the diagnostic specificity of these tests is low, and therefore they are useful only to screen for impingement and intra-articular pathology.…”

Bilateral Idiopathic Osteonecrosis of the Femoral Head: A Case Report With an Emphasis on Differential Diagnosis, Imaging, and Treatment

“…Two recently published systematic reviews of the literature have concluded that limited high quality studies exist supporting the use of hip orthopedic testing to guide clinical decision making. 17,18 Recognizing the limitations of orthopedic tests in the assessment of anterior hip pain is important as the differential diagnosis should be adjusted to reflect this poor diagnostic confidence (Fig 1). Diagnostic imaging is crucial in the diagnosis of ONFH.…”