Test library › Hip, groin & thigh
Reduced passive hip adduction (severe hip osteoarthritis)
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.
A weak test on its ownFigures as tabulated in the review.
Caution: Single study with one examiner; figures apply to severe OA only (joint space 1.5 mm or less).
How it is done
Patient supine. The examiner passively adducts the painful hip and measures the range with a goniometer. Positive: adduction under 10°, or at least 5° less than the other hip.
What the studies found
Severe radiographic hip osteoarthritis (joint space 1.5 mm or less). From Bierma-Zeinstra 2002 (220 primary-care patients aged 50 or over, 25 with severe OA), as tabulated in the Metcalfe 2019 JAMA review: sensitivity 80% (95% CI 59–93%), specificity 81% (75–86%), LR+ 4.2 (3.0–6.0), LR− 0.25 (0.11–0.54). These figures are for severe OA only; reduced adduction was much less strongly linked to OA under the study's broader definition (joint space 2.5 mm or less): odds ratio 2.2, against 17.1 for severe OA. Normal adduction makes severe hip OA less likely, but not enough to rule it out. One examiner did all the examinations. OA is often present on both sides, which can hide a side-to-side difference.
What the numbers mean
- Positive result: a small shift: a positive result nudges the diagnosis up, but does not settle it.
- 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% | 32% | 3% |
| 30% | 64% | 10% |
| 50% | 81% | 20% |
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
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) · systematic review
Also cited: 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
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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