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Table 2 Diagnostic performances of independent physical test-hip pathology combinations with moderate clinical diagnostic utility a

From: A systematic review of the diagnostic performance of orthopedic physical examination tests of the hip

Study Test Pathology Reference standard Sensitivity Specificity PPV NPV +LR -LR
(95% CI) (95% CI) (95% CI) (95% CI)
TP/ (TP+FN) TN/ (TN+FP)
Symptomatic Osteoarthritis:
Sutlive et al. 2008[25] Pain on Abduction and/or Adduction. Patient Supine. Symptomatic Osteoarthritis Radiography 0.33 0.94 0.70 0.77 5.67 0.71
0.20-0.42 0.89-0.98 1.76-19.05 0.59-0.90
7/21 48/51
Sutlive et al. 2008[25] Squat Test Symptomatic Osteoarthritis Radiography 0.24 0.96 0.71 0.75 6.07 0.79
0.13-0.31 0.91-0.99 1.46-26.32 0.70-0.96
5/21 49/51
Sutlive et al. 2008[25] 5-Part Clinical Prediction Ruleb (≥3 Variables Positive) Symptomatic Osteoarthritis Radiography 0.71 0.86 0.68 0.88 5.20 0.33
0.55-0.84 0.79-0.91 2.66-9.57 0.18-0.57
15/21 44/51
Sutlive et al. 2008[25] 5-Part Clinical Prediction Ruleb (≥4 Variables Positive) Symptomatic Osteoarthritis Radiography 0.48 0.98 0.91 0.82 24.29 0.53
0.34-0.52 0.93-1.00 4.64-145.01 0.49-0.71
10/21 50/51
Sutlive et al. 2008[25] 5-Part Clinical Prediction Ruleb (All 5 Variables Positive) Symptomatic Osteoarthritis Radiography 0.14 0.98 0.75 0.74 7.29 0.87
0.06-0.18 0.95-1.00 1.09-50.33 0.82-1.00
3/21 50/51
Loosening of Components Post-Total Hip Arthroplasty (THA)
Pooled Data: Röder et al. 2003[23] Pain on Axial Compression Uncemented Acetabular Cup Loosening Post-THA Radiography 0.08 0.99 0.20 0.98 12.15 0.93
0.03-0.17 0.99-1.00 4.33 – 32.83 0.84 – 0.97
4/49 2365/ 2381
Pooled Data: Röder et al. 2003[23] Pain on Internal Rotation Uncemented Acetabular Cup Loosening Post-THA Radiography 0.20 0.97 0.12 0.07 6.09 0.83
0.12 – 0.31 0.97 – 0.97 3.39 – 10.37 0.71 – 0.91
11/ 55 2297/ 2375
Pooled Data: Röder et al. 2003[23] Pain on External Rotation Uncemented Acetabular Cup Loosening Post-THA Radiography 0.06 0.99 0.14 0.98 7.67 0.95
0.02 – 0.14 0.99 – 0.99 2.45 – 22.97 0.86 – 0.99
3/ 49 2362/ 2381
Pooled Data: Röder et al. 2003[23] Pain on External Rotation Cemented Acetabular Cup Loosening Post-THA Radiography 0.02 1.00 0.25 0.95 5.96 0.99
0.00 – 0.04 1.00 – 1.00 0.86 – 41.13 0.96 – 1.00
1/67 1194 /1197
Pooled Data: Röder et al. 2003[23] Pain on Axial Compression Pain on Axial Compression Uncemented Femoral Stem Loosening Post-THA Uncemented Femoral Stem Loosening Post-THA Radiography 0.07 0.99 0.25 0.96 6.61 0.95
Radiography 0.02 – 0.15 0.99 – 1.00 0.25 0.96 1.55 – 27.35
6.61
0.86 – 0.99
0.07 0.99 0.95
Pooled Data: Röder et al. 2003[23] Pain on External Rotation Pain on External Rotation Cemented Femoral Stem Loosening Post-THA Cemented Femoral Stem Loosening Post-THA Radiography 0.03 1.00 0.41 0.22 8.91 0.97
Radiography 0.02 – 0.05 1.00 – 1.00 0.41 0.22 3.53 – 22.43 0.95 – 0.99
0.03 1.00 0.97
8.91
Pooled Data: Röder et al. 2003[23] Flexion ROM < 70° Uncemented Femoral Stem Loosening Radiography 0.15 0.98 0.25 0.95 5.97 0.87
0.06-0.28 0.97-0.98 1.95-16.128 0.73-0.97
5/34 594/609
Hip Fractures:
Adams et al. 1997[11] Patellar-Pubic Percussion Traumatic Fracture Radiography 0.79 0.95 0.94 0.84 17.37 0.22
0.65-0.83 0.84-0.99 3.97-98.43 0.17-0.42
15/19 21/22
Bache et al. 1984[13] Bartford test Fractured neck of femur Radiography 0.91 0.82 0.86 0.88 5.01 0.11
083 – 0.96 0.72 – 0.88 2.92 – 8.20 0.04 – 0.28
51/56 36/44
Shin et al. 1996[24] Pain on Log Roll Test Femoral Neck Stress Fracture (radiologically occult but suggestive bone scintigraphy) 6-week Follow up Radiography 1.00 0.33 0.76 1.00 1.50a 0.10
0.90-1.00 0.12-0.33 1.00 – 1.72a 0.01 – 0.98a
13/13 2/6
  1. Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (+LR), Negative Likelihood Ratio (−LR), 95% Confidence Interval (95% CI), True Positives (TP), False Positives (FP), True Negatives (TN), False Negatives (FN), Range of Motion (ROM). All values rounded to 2 decimal places. When one of the cells of the 2×2 contingency table contained the value ‘zero’, we added 0.5 to each cell in order to calculate likelihood ratio values and their confidence intervals.
  2. aStrong diagnostic utility defined as either +LR ≥ 10 or -LR ≤ 0.1 where entire 95% confidence interval satisfies these thresholds. Moderate diagnostic utility defined as +LR > 5 or -LR < 0.2 without satisfying the criteria for strong diagnostic utility.
  3. bClinical Prediction Rule consisted of 5 variables: (1) self-reported squatting as an aggravating factor, (2) scour test with adduction causing groin or lateral pain, (3) active hip flexion causing late pain, (4) active hip extension causing hip pain, and (5) passive hip internal rotation less than or equal to 25°.