Hip OA / mobility CPG

Question 1

Hip OA

Answer 1

General:

• moderate pain lateral/anterior hip while WB
• >50
• limited PROM in 2/6 directions
• AM stiffness, improves in < 60 min

Altman

• Hip internal rotation less than 15° (24^o?) AND
• Hip flexion less than or equal to 115° AND
• Age greater than 50 years

OR

• Hip internal rotation greater than or equal to 15° AND
• Pain with hip internal rotation AND
• Duration of morning stiffness of the hip <= 60 min AND
• Age greater than 50 years

Sn 86%; Sp 75%; +LR 3.44, -LR, 0.19

Question 2

Hip OA exam - outcome

A

Answer 2

• Western Ontario
• McMaster Universities OA index
• LEFS
• Harris hip score

Question 3

Hip FAI

Answer 3

• Risk factors: genetics & gender (M>F)
  *

Question 4

Hip outcome tools - non-OA

(STRONG evidence)

Answer 4

• Hip coutcome score
  
  • MDC 3 pts
  • MCID 9pts ADL, 3 pts sports
• Copenhagen hip and groin outcome score (HAGOS)
  
  • MDC 5.2
• International hip outcome tool (iHOT-33)
  
  • MCID scope 6 points

Question 5

Hip OA Risk Factors

Answer 5

• Age
  
  • 60-64 AOR 1.3
  • 65-69 AOR 2.38
  • 70-74 AOR 2.38
• Developmental disorders
  
  • LCP, SCFE, dysplasia
• Previous injury
• Reduced ROM, presence of osteophytes, lower socieconomic status, higher bone mass, higher BMI

Question 6

Hip outcome tools - OA

(strong evidence)

Answer 6

• WOMAC
  
  • MCID 12-22%
• LEFS
  
  • MCID 9 pts
• Hip Disability and OA Outcome Measure (HOOS)
• LEFS
• Harris Hip Score
  *

Question 7

Hip OA interventions

Answer 7

• NSAIDs - Level I
• CSI / visco supplementation - Level I
• Glucoasmine/chondritin NOT recommended - Level I
• Education - activity mod, exercise, weight reduction - Grade B
• Functional, gait & balance training - Grade C
• Manual therapy - Grade B–>A
• ROM, flexibility/strength, aerobic conditioning - Grade B–>A
• Ultrasound –> Grade B

Question 8

Hip OA exam measures

Answer 8

• 6 minute walk
• 30-sec chair stand
• stair measure
• self-paced walk
• timed up and go
• timed single leg stance
• four square step test
• step test
  *

Question 9

FAI diagnosis

Clinical

Answer 9

• anterior / lateral hip pain
• “aching or sharp”
• aggravated by sitting
• reproduced with FADIR
• IR < 20^o at 90^o of flexion
• FLEX / ABD also limited
• popping, locking, clicking

Question 10

FAI diagnosis

(radiological)

Answer 10

• Cam impingement
  
  • increased femoral neck diamter
    
    • alpha angle > 60
    • head-neck offset ratio < 0.14
• Pincer impingement
  
  • increased acetabular depth
    
    • coxa profunda (lateral-center edge >35)
    • acetabular protrusion
  • decreased acetabular inclination
    
    • Tonnis angle <0
  • acetabular retroversion
    
    • crossover sign
    • ischial spine projection into pelvis

Question 11

structural instability

(dysplasia)

Answer 11

Clinical

• anterior groin, lateral hip, generalized pain
• FADIR/FABER rpeduces
• • hip apprehension
• IR > 30 at 90^o flexion
• popping, locking, clicking

Radiographic

• increased acetabular inclination
• Tonnis angle > 10
• Lateral center edge of WIber < 25
• Anterior center edge angle < 20

Question 12

Intra-articular injury

Answer 12

Clinical

• anterior groin pain or generalized pain
• +FADIR/FABER
• popping, clicking, locking, snapping
• may report feelings of instability

Radiological

• MRA labral tear

Question 13

Evidence-based tests & measures

(NOT OA)

Reliability

Answer 13

• Trendelenburg 0.58
• FABER 0.63
• FADIR 0.58
• Log roll 0.61
• MMT (ABD)