Cluster of Sutlive | Hip Osteoarthritis Test Cluster | Hip Assessment

The cluster of Sutlive is a 5-item test cluster that can aid in the preliminary diagnosis of hip osteoarthritis in patients who complain of unilateral hip pain. While current practice is radiographic evaluation of joint space narrowing, presence of osteophytes,  bony changes on joint margins, as well as changes of subchondral bone according to the Kellgren & Lawrence scale, the clinical prediction rule of Sutlive aims to reduce the need for such radiographs and provides clinicians with a tool to initiate early conservative management.

According to Sutlive et al. (2008), 3 out of 5 positive items result in a positive likelihood ratio of 5.2. In the case of 4 out of 5 positive items, the positive likelihood ratio rises to 24.3. The latter has to be used with caution due to the very large confidence interval ranging from 4.4 to 142.1. Furthermore, the clinical prediction rule needs additional validation which is why we attribute a moderate clinical value.

The five items of the cluster are:

1) A positive hip scour test. With the patient lying in supine position passively flexed the hip to 90°. Move the hip towards the opposite shoulder and apply an axial load through the femur. Assess the patient’s symptoms in the groin. Then move the hip into internal rotation and axial compression, consequently moving it into adduction and compression. Again assess for the patient’s pain in the groin or any other symptom reproduction.

2) Passive hip internal rotation <= 25°.To assess internal rotation the patient lies in prone with the hips in neutral position. Flex the knee of the affected leg to 90° and hold an inclinometer just proximal to the lateral malleolus and then perform maximal internal rotation of the hip. Maximum ROM is reached once the contralateral buttock begins to rise from the table.

3)Hip pain when squatting.

4) Active hip flexion causes lateral pain

5) Active hip extension is painful.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

• • Name*
• • Email*

Δ

Other assessments for hip osteoarthritis are:

• Patrick’s Test
• Trendelenburg Sign
• Signs & Symptoms of Hip OA

References

Sutlive, T. G., Lopez, H. P., Schnitker, D. E., Yawn, S. E., Halle, R. J., Mansfield, L. T., … & Childs, J. D. (2008). Development of a clinical prediction rule for diagnosing hip osteoarthritis in individuals with unilateral hip pain. Journal of Orthopaedic & Sports Physical Therapy, 38(9), 542-550.