Osteoarthritis of the hip is a common condition physical therapists see in the clinic. The fundamental radiological and pathological characteristic of osteoarthritis of the hip is joint space loss. Consequently, the best radiological criterion used to detect osteoarthritis of the hip is by measuring joint space width. Because most physical therapists do not have immediate access to radiographs and do not have the ability to order radiographs, they must either rely on a physician to order a hip radiograph or rely on a clinical method to diagnose osteoarthritis of the hip. Radiographs, though usually helpful in the diagnosis of severe hip osteoarthritis, are not always beneficial in the diagnosis of mild or moderate hip osteoarthritis. In patients with severe hip osteoarthritis, radiographs usually show joint space narrowing, subchondral sclerosis, or osteophytes. However, patients with early osteoarthritis often do not show these kind of radiographic changes. Thus, relying only on radiographs to determine osteoarthritis of the hip, especially in patients with early or mild hip osteoarthritis, can result in false-negative diagnosis. Using the clinical presentation (signs and symptoms) along with imaging findings will likely improve the diagnosis of osteoarthritis of the hip. The ability to clinically determine osteoarthritis of the hip without a radiograph, especially in early cases, would be valuable to many clinicians, not just physical therapists. Finding a clinical method to detect osteoarthritis of the hip would give physical therapists an opportunity for early intervention. Early intervention may improve the chance of clinical success. A number of studies have suggested using a clinical method to diagnose hip osteoarthritis. Studies by Altman et al, Birrell et al, and Bierma-Zienstra et al have recommended using clinical variables, such as pain location or duration, hip range of motion, age, or aggravating movement. Among the different clinical criteria, diminished hip range of motion is the most common component used to indicate the presence of hip joint osteoarthritis. Using hip motion to diagnose hip problems is not new. Many studies have shown the relationship between different hip conditions and diminished hip motion. For example, osteoarthritis of the hip has been linked to patients with femoral neck retroversion, where hip external rotation is increased while hip internal rotation is limited. In osteoarthritis of the hip, the first 2 motions that are diminished are usually hip internal rotation and hip flexion. The purpose of this paper is to describe how we made a clinical diagnosis of osteoarthritis of the hip in a patient with diminished hip range of motion and hip pain.
J Orthop Sports Phys Ther. 2004;34(8):461-467. doi:10.2519/jospt.2004.1313
The original article was corrected in September 2007, and the amended article PDF is provided here. Please see Correction: Altman's criteria for osteoarthritis of the hip and knee. J Orthop Sports Phys Ther. 2007; 37(9):573.
Key Words: osteoarthritis, hip motion, hip pain, radiograph