Clinical Examination of the Hip

Common Clinical Cases

  • Primary Osteoarthritis

  • Post Traumatic Osteoarthritis

  • AVN (Avascular Necrosis)

  • Rheumatoid Hip

  • Fused Hip

  • Ankylosing Spondylitis

  • Old Perthes, DDH, or SCFE

  • Femoroacetabular Impingement

  • Painful Hip After THR

  • Infected THR

  • Protrusio Acetabuli

  • Tuberculosis of the Hip

  • Multiple Epiphyseal Dysplasia

  • Paget’s Disease of the Hip

Examination of the Hip

Look (Standing)

  • Front:
    • Pelvic obliquity
    • Scars
    • Sinuses
    • Muscle wasting
    • Obvious leg length discrepancy
  • Back:
    • Spine: Scoliosis, lordosis, or kyphosis
    • Walking aids
  • Shoes: Wear patterns
  • Block Test: Assess leg length discrepancy
  • Trendelenberg Test

Gait Assessment

  • Key Observations:
    • Antalgia: Stance phase shortening
    • Trendelenberg:
      • Dipping of contralateral pelvis in single leg stance
      • Shoulder sway to ipsilateral side
    • Short Leg:
      • Equinus foot
      • Knee flexed
      • Contralateral circumduction
    • Stiff Hip Gait:
      • Hitching pelvis instead of hip flexion
    • Foot Progression Angle:
      • Rotational deformity

Look (Lying)

  • Check pelvis alignment
  • Measure leg lengths: True and apparent
  • Comment on skin quality of lower legs

Feel

  • Palpate over greater trochanter and groin
  • Palpate while coughing

Move

  • Thomas Test:
    • Hand in lumbar lordosis
    • Flex hip until lordosis obliterates
    • Quantify fixed flexion
    • Compare both hips
  • Abduction: Hand on opposite ASIS
  • Adduction: Hand on same ASIS
  • External/Internal Rotation: Check in extension and flexion

Comment on contractures

Measurements

Special tests

Finishing

  • Palpate pulses
  • Check distal sensation
  • Examine spine and knee

Arthrodesed Hip: Examination Findings

Observations

  • Pelvic obliquity
  • Compensatory scoliosis
  • Hyperlordosis
  • Leg shortening
  • Scars
  • Fixed flexion deformity (no abduction/rotation)
  • Pelvic tilt with motion
  • False positive Trendelenberg test

Gait

  • Asymmetric pattern
  • Slow walking
  • Short stance phase
  • Prolonged swing phase
  • Increased lumbar lordosis
  • Pelvic tilts with exaggerated rotation
  • Equinus compensation
  • Opposite knee flexed

Don’t Forget:

- Examine spine, other hip, and knee

- Neurovascular status

- Investigate abductor function

Ankylosing Spondylitis: Examination Findings

Observations

  • Posture:
    • Question mark posture
    • Loss of lumbar lordosis
    • Reduced forward gaze
    • Hips and knees flexed during gait
  • Fixed Deformities:
    • Bilateral fixed flexion deformities

Additional Checks:

- Chest wall expansion

- Chin-brow angle

- Forward gaze angle

- Occiput-wall distance

Important Note: - High-risk case for anesthetist

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