Hip Osteoarthritis

Procedure

Patient supine. Flex the affected hip and knee, place the lateral ankle on the opposite knee, then gently apply overpressure to the bent knee toward the table. Pain in the groin or anterior hip suggests positive finding.

Positive Finding

Groin pain or anterior hip pain, or inability to achieve full range of motion with overpressure

Interpretation

A general screen for pain from the hip joint; it does not identify osteoarthritis specifically. Groin or anterior hip pain is the meaningful finding; lateral or posterior pain points away from the joint, towards extra-articular or sacroiliac sources. Corroborate with loss of internal rotation, the rest of the examination, and imaging. A 2019 systematic review of examination findings for hip osteoarthritis (Metcalfe et al., JAMA; 6 studies, 1,110 patients, x-ray as the reference) found no study of the FABER test, so no figure is shown. The figures sometimes quoted for FABER come from studies of other hip problems. The findings that best supported osteoarthritis were groin pain on passive abduction or adduction, pain at the back of the hip on squatting, weak hip abductors, and reduced passive adduction or internal rotation.

Procedure

Patient supine, hip flexed to 90° and knee flexed to 90°. Internally rotate the hip by rolling the lower leg medially. Assess for pain and range of motion restriction.

Positive Finding

Groin or anterior hip pain; restriction of internal rotation ROM (normally 30–45°)

Interpretation

Loss of hip internal rotation is one of the more useful examination findings in hip osteoarthritis. The log roll assesses that rotation with the limb relaxed, so pain and end-feel reflect the joint and capsule rather than muscle guarding. A 2019 systematic review of examination findings for hip osteoarthritis (Metcalfe et al., JAMA; 6 studies, 1,110 patients, x-ray as the reference) found no study of the log roll itself. Reduced passive internal rotation (pooled from 4 studies, 788 hips) was present in 66% of hips with osteoarthritis and absent in 79% without, so it makes osteoarthritis somewhat more likely. Pain on internal rotation was common in both groups (sensitivity 82–88%, specificity 38–39%).

Procedure

Patient supine at end of table. Flex one knee to chest to eliminate lumbar lordosis. Assess hip flexion contracture of opposite hip; measure angle between thigh and horizontal plane.

Positive Finding

Hip cannot extend fully to neutral; thigh remains elevated above the table (positive Thomas angle)

Interpretation

Documents loss of hip extension, common in hip osteoarthritis from capsular tightness and pain-avoidance posturing, but does not diagnose it. No diagnostic-accuracy study establishes sensitivity or specificity for the Thomas test in hip osteoarthritis. A 2019 systematic review of examination findings for hip osteoarthritis (Metcalfe et al., JAMA; 6 studies, 1,110 patients, x-ray as the reference) found no study of the Thomas test.

Procedure

Patient standing on one leg (affected side) for 20–30 seconds, or observe during single-leg stance and gait. Look for ipsilateral pelvic drop or trunk lean toward the stance leg.

Positive Finding

Pelvis drops on non-stance side; trunk leans toward stance side to maintain balance

Interpretation

Indicates hip abductor insufficiency — from pain inhibition, gluteal tendinopathy or superior gluteal nerve involvement — and is not specific to osteoarthritis. Often accompanies lateral hip pain and gait dysfunction. No diagnostic-accuracy study establishes sensitivity or specificity for this test in hip osteoarthritis.

Procedure

Patient supine. Hip flexed to 90°, knee flexed to 90°. Adduct the hip across the midline while internally rotating. Apply gentle overpressure at the end of range.

Positive Finding

Groin pain or anterior hip pain with this movement pattern

Sensitivity / Specificity

Reference: Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med 2015;49(12):811; PMID 25515771

Interpretation

A near-perfect screening test and a poor confirmatory one. Pooled sensitivity 0.94-0.99, so a NEGATIVE FADIR is genuinely useful — it makes intra-articular hip pathology unlikely. A POSITIVE is close to uninformative on its own, because specificity is very low: it is positive in osteoarthritis, labral tears, impingement and a substantial proportion of asymptomatic hips. Note the pooled figures were derived in impingement and labral tear cohorts rather than osteoarthritis, so they transfer only approximately.