Dr Walter examines patient with arthritic hip joint

Arthritic hip: examination video (6 min). In this video, Professor 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, 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 – 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