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Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis
  1. Michael P Reiman1,
  2. Adam P Goode1,
  3. Eric J Hegedus2,
  4. Chad E Cook3,
  5. Alexis A Wright2
  1. 1Community and Family Practice, Duke University School of Medicine, Durham, North Carolina, USA
  2. 2Physical Therapy, High Point University, High Point, North Carolina, USA
  3. 3Physical Therapy, Walsh University, North Canton, Ohio, USA
  1. Correspondence to Michael P Reiman, Duke University School of Medicine, Community and Family Practice, 2200 W. Main, Durham, North Carolina 27705, USA; michael.reiman{at}


Background Hip Physical Examination (HPE) tests have long been used to diagnose a myriad of intra-and extra-articular pathologies of the hip joint. Useful clinical utility is necessary to support diagnostic imaging and subsequent surgical decision making.

Objective Summarise and evaluate the current research and utility on the diagnostic accuracy of HPE tests for the hip joint germane to sports related injuries and pathology.

Methods A computer-assisted literature search of MEDLINE, CINHAL and EMBASE databases (January 1966 to January 2012) using keywords related to diagnostic accuracy of the hip joint. This systematic review with meta-analysis utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the search and reporting phases of the study. Der-Simonian and Laird random effects models were used to summarise sensitivities (SN), specificities (SP), likelihood ratios and diagnostic OR.

Results The employed search strategy revealed 25 potential articles, with 10 demonstrating high quality. Fourteen articles qualified for meta-analysis. The meta-analysis demonstrated that most tests possess weak diagnostic properties with the exception of the patellar-pubic percussion test, which had excellent pooled SN 95 (95% CI 92 to 97%) and good specificity 86 (95% CI 78 to 92%).

Conclusion Several studies have investigated pathology in the hip. Few of the current studies are of substantial quality to dictate clinical decision-making. Currently, only the patellar-pubic percussion test is supported by the data as a stand-alone HPE test. Further studies involving high quality designs are needed to fully assess the value of HPE tests for patients with intra- and extra-articular hip dysfunction.

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  • Funding Dr. Goode receives funding from the NIH Loan Repayment Program, National Institute of Arthritis Musculoskeletal and Skin Diseases (1-L30-AR057661-01) and is supported by Agency for Health Care Research and Quality (AHRQ) K-12 Comparative Effectiveness Career Development Award grant number HS19479-01. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the AHRQ or NIAMS.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • ▸ References to this paper are available online at