1. EXAMINATION OF THE
HIP JOINT

2. CURRENT TREND
Clinical examination
Early imaging

3. IN ORTHOPAEDIC TRAINING
• The skill in
eliciting/demonstrating
abnormalities of the hip
remains as the mainstay
in assessment of
orthopaedic trainee

4. CLINICAL EXAMINATION OF HIP
USEFUL IN
• DDH
• NEONATAL SEPTIC
ARTHRITIS
• TRANSIENT
SYNOVITIS
• PERTHES DISEASE
• SUFE
• TUBERCULOSIS
• OSTEOAARTHROSIS
• TRAUMATIC
CONDITIONS

5. EXAMINATION OF HIP
Traditional steps
• History of
symptoms
• Relevant general
examination
• Gait
• Inspection
• Palpation
• Looking for Fixed
deformities
• Movements
• Measurements
• Special tests
• Tests for instability

6. HISTORY
• Pain
• Felt in
groin, thigh
or knee
• Limping
• Also an early
symptom

7. RELEVANT GENERAL
EXAMINATION
• For the diagnosis
&
• Its management

8. RELEVANT GENERAL
EXAMINATION
For the diagnosis

9. RELEVANT GENERAL
EXAMINATION
Not relevant for diagnosis

10. RELEVANT GENERAL
EXAMINATION
For his management

11. GAIT
• Simplest of all definitions “mode of
walking”

12. GAIT
• Normal gait is rhythmical bipedal
biphasic walking in which the lumbar
spine, hip and legs move in unison

13. GAIT

14. LIMPING
• Limping is the most common
abnormality
• Can be defined as any abnormality of
normal rhythmic biphasic walking

15. GAIT
• Types
– Painless limping
– Painful limping
– Stiff hip
– High stepping
– Crutch gait

16. STIFF HIP GAIT

17. CRUTCH WALKING
– Two point
– Three point
– Swing to
– Swing through

18. CRUTCH GAIT
Three point gait Swing through gait Swing to gait

19. INSPECTION
• Attitude
Lumbar lordosis
ASIS
Lower limbs

20. INSPECTION
Muscle wasting

21. INSPECTION
• Swelling
• Scars
• Sinuses

22. PALPATION
• TENDERNESS
– ANTERIOR
– Posterior & lateral
– Bitrochanteric compression

23. PALPATION
• Swelling

24. PALPATION
• Femoral artery
pulsation
Weak or absent

25. FIXED DEFORMITIES
• Fixed flexion deformity
Concealed during walking by increase in lumbar
lordosis

26. FFD DEMONSTRATION
HUGH OWEN THOMAS’S TEST

27. FFD DEMONSTRATION

28. FIXED ABDUCTION &
ADDUCTION DEFORMITY
• Pelvic tilt indicated by ASIS at
different level

29. FIXED ABDUCTION &
ADDUCTION DEFORMITY
DN

30. FIXED ABDUCTION &
ADDUCTION DEFORMITY
N
D

31. FIXED ABDUCTION &
ADDUCTION DEFORMITY
N D

32. FIXED ABDUCTION &
ADDUCTION DEFORMITY
N
D

33. MOVEMENT
Normal flexion
Normal range

34. MOVEMENT
Axis deviation

35. MOVEMENTS
Extension

36. MOVEMENTS
ADDUCTION
Normal range

37. MOVEMENTS
Abduction
In flexion
Normal range

38. MOVEMENTS
Internal rotation
In flexion
Normal range

39. MOVEMENTS
External rotation
In flexion
Normal range

40. MEASUREMENTS
• Shortening
–Apparent
–True

41. MEASUREMENTS
• Apparent
shortening
• Due to pelvic tilt or
FFD
• Measured from
xiphisternum to
medial malleolus

42. MEASUREMENTS
True shortening
Square the pelvis
ASIS  MEDIAL JOINT LINE KNEE  MEDIAL MALLEOLUS

43. MEASUREMENTS
True shortening- Supra Trochanteric
Bryants
triangle
Nelatons
line

44. MEASUREMENTS
Supra trochanteric
• Coxa Vara
• Perthes
• SCFE
• Malunited basal # NOF
• Congenital Coxa Vara
• Arthritis
• Dislocation
Infra trochanteric
– Malunion
– Fracture femur & tibia
– Growth arrest from
polio
– Trauma and infective
sequale
True shortening

45. MEASUREMENT
• Muscle wasting

46. SPECIAL TESTS
• Trendeleberg Test
• Fulcrum  socket
• Lever  length of head
and neck
• Force  Gluteus Medius

47. HIP ABDUCTION MECHANISM
12
3

48. SPECIAL TESTS
Trendelenberg test
Normal hip Positive test

49. SPECIAL TESTS
Telescoping test

50. SPECIAL TESTS
• Ortolani test
• Barlow’s test
• Patrick test
• Febere sign
• Duchnne sign

51. Thank you