Dr Bill Walter examines patient with arthritic hip joint
Arthritic hip: examination video (6 min). In this video, Professor Bill Walter carefully assesses a patient with an arthritic hip, prior to hip replacement surgery.
A patient history is taken and considers:
- Pain profile – pain severity, pain duration, the location of pain, radiation of pain and actions which exacerbate or relieve pain.
- Joint profile – includes asking about clicking, catching and stiffness in the hip joint.
- Activity profile – the patient is asked what activities are limited by the hip pain.
A physical examination assesses the patient for:
- Quadriceps wasting
- Trendelenburg sign or Trendelenburg “lurch” (Upper body swing due to pain and weakness upon walking)
- Leg length discrepancy can be identified by examining iliac crests when standing
- Position of occiput over sacrum, as this can indicate spinal imbalance which can be important in hip pathology.
- Tape measure used to measure leg length from anterior superior iliac spine to medial malleolus. Leg length discrepancy confirmed and recorded.
- Pulses, sensation and motor function are checked.
- Hip range of motion assessed: extension, flexion, internal rotation, external rotation, abduction, adduction.
- Thomas’ Test for fixed flexion contracture.
- Groin is checked for previous scarring and masses.
X-ray and MRI is examined to diagnose:
- Avascular necrosis
- Narrowing of joint space
- Subchondral collapse
- Subchondral sclerosis
- Crescent sign
- Avascular segment
- Osteophytes