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Hip Pain And Radiographic Hip Osteoarthritis

Q: Is There Concordance Between Hip Pain And Radiographic Hip Osteoarthritis?

A: No!

“In the Framingham study (n=946), only 15.6% of hips in patients with frequent hip pain showed radiographic evidence of hip osteoarthritis, and 20.7% of hips with radiographic hip osteoarthritis were frequently painful. The sensitivity of radiographic hip osteoarthritis for hip pain localized to the groin was 36.7%, specificity 90.5%, positive predictive value 6.0%, and negative predictive value 98.9%. Results did not differ much for hip pain at other locations or for painful internal rotation. (1)

In the Osteoarthritis Initiative study (n=4366), only 9.1% of hips in patients with frequent pain showed radiographic hip osteoarthritis, and 23.8% of hips with radiographic hip osteoarthritis were frequently painful. The sensitivity of definite radiographic hip osteoarthritis for hip pain localized to the groin was 16.5%, specificity 94.0%, positive predictive value 7.1%, and negative predictive value 97.6%. Results also did not differ much for hip pain at other locations.” (1,2)

Patients with hip OA are equally likely to present with hip pain as those without hip OA. The radiographic diagnosis of hip OA must be correlated with a functional exam and history. Most patients with a high suspicion for clinical hip osteoarthritis pain (+C-Sign, FADIR, Hip Scour, or FABER tests) did not have radiographic hip osteoarthritis. Symptoms often arise from the repetitive and postural stresses placed upon a specific joint. Like other joints, the symptoms of hip OA may arise primarily from the biomechanical precursors and sequellae of OA rather than the OA itself.

To study the current “best practice” assessment and management of hip pain, subscribers can review the ChiroUp protocols for Hip Osteoarthritis, FAI, and Greater Trochanteric Pain Syndrome.

1. Kim C, Linsenmeyer KD, Vlad SC, et al. Prevalence of radiographic and symptomatic hip osteoarthritis in an urban United States community: the Framingham osteoarthritis study. Arthritis Rheumatol 2014;66:3013-7.
2. The Osteoarthritis Initiative: A multi-center observational study of men and women. http://www.oai.ucsf.edu/datarelease/ Accessed 12/22/15

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