Test library › Hip, groin & thigh
Severe hip osteoarthritis cluster (Bierma-Zeinstra, 7 signs)
For: Severe hip osteoarthritis
Website-only test: not part of the book.
Advanced wear of the hip joint, with the joint space on X-ray narrowed to 1.5 mm or less. Usually causes groin or hip pain and stiffness, with loss of hip movement.
Treat with caution (see below)LR+ 35 as given in the Metcalfe 2019 review; LR− 0.29 calculated from the study's counts at the 5-or-more cut-off. The review's banded figure of 0.05 applies only to 3 or fewer signs.
Caution: Single study with one examiner and only 25 people with severe OA; never independently re-tested.
How it is done
Count how many of these 7 are present: age over 60; tenderness over the inguinal ligament; reduced passive hip external rotation; reduced passive hip internal rotation; reduced passive hip adduction; a hard (bony) end-feel limiting at least one passive hip movement; hip abductor weakness. Measure with a goniometer: external or internal rotation counts as reduced if under 21°, or at least 5° less than the other hip; adduction if under 10°, or at least 5° less than the other hip. Positive: 5 or more of the 7.
What the studies found
Severe radiographic hip osteoarthritis (joint space 1.5 mm or less). Bierma-Zeinstra et al. 2002 examined 220 consecutive adults aged 50 or over whose GP referred them for a hip X-ray (pain for 2 weeks to 2 years); 25 had severe OA. With 5 or more signs: sensitivity 72%, specificity 98% (18 of 25 with severe OA positive; 4 of 195 without). The Metcalfe 2019 JAMA review reports the result in bands: 5 or more signs, LR 35 (95% CI 13–95); exactly 4 signs, LR 2.0 (0.88–4.3), which barely changes the probability; 3 or fewer, LR 0.05 (0.01–0.32), which makes severe OA very unlikely. These bands are separate cut-offs: the LR− shown above (0.29) is for fewer than 5 signs. All examinations were done by one examiner, the cluster was built and tested in the same patients, and it has not been tested again. It targets severe OA only. The paper gives the age item as 'over 60' in one table and '60 or over' in another.
What the numbers mean
- Positive result: see the caution above before relying on this result.
- Negative result: a small shift: a negative result nudges the diagnosis down, but does not exclude it.
The ladder: what a result does to your estimate
| If you thought | After a positive | After a negative |
|---|---|---|
| 10% | 80% | 3% |
| 30% | 94% | 11% |
| 50% | 97% | 22% |
Calculated from the likelihood ratios above. Read the caution above before relying on these. For any other starting estimate, use the probability calculator.
Work out what a result means for your patient: probability calculator
Other tests in the library for severe hip osteoarthritis
Source
Bierma-Zeinstra SM, Oster JD, Bernsen RM, Verhaar JA, Ginai AZ, Bohnen AM. Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care. J Rheumatol. 2002;29(8):1713–1718. PubMed · single study
Also cited: Metcalfe D, Perry DC, Claireaux HA, Simel DL, Zogg CK, Costa ML. Does this patient have hip osteoarthritis? The rational clinical examination systematic review. JAMA. 2019;322(23):2323–2333. Journal article (DOI)
Website-only test: added to the library on 9 October 2026 and not part of Rule It In, Rule It Out. Figures independently checked against the sources cited above; any note above says where only the abstract could be checked. If a newer or better study changes them, this page will be updated.
Get the book for telling the hip joint from the lateral hip, and ruling out the runner's stress fracture first
This test is in the website library only; it is not one of the tests in Rule It In, Rule It Out. The book covers the tests in its ‘The hip and groin’ chapter: how to do each one, what counts as positive, and how to read the result.
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