Sensitivity and Specificity for Physical Examination Tests in Diagnosing Prearthritic Intra-Articular Hip Pathology Are Highly Variable: A Systematic Review

Abstract

Purpose

To perform a systematic review of the accuracy of various physical examination tests for diagnosing prearthritic intra-articular hip pathology.

Methods

A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, Embase, and the Cochrane Library to identify studies that measured sensitivity and/or specificity of various physical examination tests for diagnosing prearthritic intra-articular hip pathology such as a labral tear, femoroacetabular impingement (FAI), or microinstability of the hip joint. The search phrase used was hip AND (exam OR examination) AND pain AND (sensitivity OR specificity). A total of 15 studies (4 Level I, 6 Level II, and 5 Level III) met the inclusion criteria, including a total of 1,378 hips. The patients had a mean age range of 16.0 to 60.2 years, with males ranging from 11% to 100% of the cohort. For diagnosing hip labral tears, the FADIR (flexion, adduction, internal rotation) test showed the highest sensitivity of 100%, and the FABER (Flexion, Abduction, External Rotation) test showed the highest specificity of 100% based on reference standard comparisons of magnetic resonance imaging (MRI) and direct visualization during hip arthroscopy (HA), respectively. For diagnosing FAI, the IROP (Internal Rotation Over Pressure) test showed the highest sensitivity of 91%, and the FADIR test showed the highest specificity of 47% based on reference standard comparisons of MRI and HA, respectively. For diagnosing hip microinstability, the AB-HEER (abduction–hyperextension–external rotation) test showed the highest sensitivity of 80.6%, and the Prone Instability test showed the highest specificity of 97.6% based on reference standard comparisons of MRI and HA, respectively.

Conclusions

This study found high variability in the sensitivity and specificity of physical examination tests for diagnosing prearthritic intra-articular hip disorders.