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


CONCLUSIONS
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.
Department of General Practice, Erasmus University, Rotterdam, The Netherlands. Bierma@hag.fgg.eur.nl
Sita M A
SM
Bierma-Zeinstra
J Dorinde
JD
Oster
Roos M D
RM
Bernsen
Jan A N
JA
Verhaar
Abida Z
AZ
Ginai
Arthur M
AM
Bohnen
D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010146:Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012372:ROC Curve; D011859:Radiography; D012017:Referral and Consultation