Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care

J Rheumatol. 2002 Aug;29(8):1713-8.

Abstract

Objective: To study whether clinical symptoms and signs can predict radiological osteoarthritis (OA) of the hip in primary care patients with hip pain.

Methods: Consecutive patients (n = 220) aged 50 years or older consulting the general practitioner for hip pain and referred for radiological investigation underwent a standardized history, radiological, laboratory, and physical examination. Radiological OA was confirmed with joint space < or = 2.5 mm. Additionally, a more stringent definition was used (< or = 1.5 mm). The relationship between radiological OA and possible clinical symptoms/signs of OA was tested. Combinations of clinical symptoms/signs that had shown an independent relationship with radiological OA in multivariate analyses were tested for their predictive value.

Results: Radiological OA (joint space < or = 2.5 mm) of the (more) symptomatic hip was present in 35.5% of the study population and more severe OA (joint space < or = 1.5 mm) in 11.4%. Presence of 4 specific symptoms/signs from history and examination showed a positive predictive value (PPV) of 73% (specificity 91%, sensitivity 45%) for radiological OA. When 5 specific symptoms/signs were present, the PPV for the more severe radiological OA was 82% (specificity 98%, sensitivity 72%), and when 6 or 7 specific symptoms/signs were present the PPV was 100% (specificity 100%, sensitivity 40% and 8%, respectively). Negative predictive values were high for almost all combinations.

Conclusion: In primary care patients with hip pain, clinical symptoms and signs can to a moderate extent predict radiological OA and to a large extent more severe radiological OA.

MeSH terms

  • Female
  • Hip Joint / diagnostic imaging*
  • Hip Joint / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / complications
  • Osteoarthritis, Hip / diagnostic imaging*
  • Osteoarthritis, Hip / physiopathology
  • Pain / diagnostic imaging*
  • Pain / etiology
  • Pain / physiopathology
  • Predictive Value of Tests
  • Primary Health Care
  • ROC Curve
  • Radiography
  • Referral and Consultation