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Make the Diagnosis: Does This Patient Have Hip Osteoarthritis?

Prior Probability of Hip Osteoarthritis

The prevalence of symptomatic hip osteoarthritis among people aged 60 years and older is 6.2%. Among patients (mean age, 63-66 years) who present to a primary care physician for hip or groin pain, the prevalence of at least mild to moderate hip osteoarthritis is approximately 35%, with 11% to 14% having severe osteoarthritis.

Population Among Whom Hip Osteoarthritis Should Be Considered

Pain from hip osteoarthritis can be felt over a diffuse region (see Figure 109-1). Besides hip osteoarthritis, the differential diagnosis includes greater trochanteric pain syndrome, piriformis syndrome, stress fracture, inflammatory arthropathies, lumbar radiculopathy, bone tumors, osteonecrosis, and nonmusculoskeletal causes such as groin pain, intrapelvic pathology, or an abdominal aortic aneurysm. Patients more likely to have hip osteoarthritis include those with a family history of osteoarthritis (LR, 2.1; 95% CI, 1.2-3.6) or a personal history of knee osteoarthritis (LR, 2.1; 95% CI, 1.1-3.8). Pain on climbing stairs or walking down slopes is the best symptom for identifying patients with hip osteoarthritis (LR, 2.1; 95% CI, 1.6-2.8). Patients younger than 60 years are less likely to have hip osteoarthritis (LR, 0.11; 95% CI, 0.02-0.78) than those aged 60 years and older.

Figure 109-1.

Distribution of Pain Typically Arising From Hip Osteoarthritis

Assessing the Likelihood That a Patient With Hip Pain Has Osteoarthritis

The physical examination is more useful than historical features for identifying patients with hip osteoarthritis (see Table 109-1). Physical examination maneuvers evaluate the extent of hip motion and pain during motion. Rather than relying on single findings, a composite of measures might be more helpful for identifying those affected by any hip osteoarthritis as opposed to severe hip osteoarthritis (see Table 109-2).

Table 109-1.Useful Findings for Identifying Hip Osteoarthritis
Table 109-2.Combinations of Findings for Identifying Hip Osteoarthritis

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