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

Rahman, Labib Ataur; Adie, Sam; Naylor, Justine Maree; Mittal, Rajat; So, Sarah; Harris, Ian Andrew

doi:10.1186/1471-2474-14-257

BMC Musculoskeletal Disorders

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)			(95% CI)	(95% CI)
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			1.76-19.05	0.59-0.90
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			1.46-26.32	0.70-0.96
Sutlive et al. 2008[25]	5-Part Clinical Prediction Rule^b (≥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			2.66-9.57	0.18-0.57
Sutlive et al. 2008[25]	5-Part Clinical Prediction Rule^b (≥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			4.64-145.01	0.49-0.71
Sutlive et al. 2008[25]	5-Part Clinical Prediction Rule^b (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			1.09-50.33	0.82-1.00
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			4.33 – 32.83	0.84 – 0.97
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			3.39 – 10.37	0.71 – 0.91
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			2.45 – 22.97	0.86 – 0.99
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			0.86 – 41.13	0.96 – 1.00
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
			Radiography	0.07	0.99	0.25	0.96	1.55 – 27.35 6.61	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			3.53 – 22.43	0.97
				0.03	1.00			8.91	0.97
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			1.95-16.128	0.73-0.97
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			3.97-98.43	0.17-0.42
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			2.92 – 8.20	0.04 – 0.28
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	1.50^a	0.10
				0.90-1.00	0.12-0.33			1.00 – 1.72^a	0.01 – 0.98^a
				13/13	2/6			1.00 – 1.72^a	0.01 – 0.98^a

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.
^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.
^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°.

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ISSN: 1471-2474

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