Sonography for hip joint effusion in adults with hip pain

• Published in: Annals of the rheumatic diseases Vol. 59; no. 3; pp. 178 - 182
• Main Authors: Bierma-Zeinstra, S M A, Bohnen, A M, Verhaar, J A N, Prins, A, Ginai-Karamat, A Z, Laméris, J S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.03.2000; BMJ; BMJ Publishing Group LTD
• Subjects: Aged; Analgesics; Arthritis; Biological and medical sciences; Disease; Extended Report; Exudates and Transudates - diagnostic imaging; Family medical history; Female; Hip joint; Hip Joint - diagnostic imaging; Hip Joint - pathology; Hip Joint - physiopathology; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Joint Diseases - diagnostic imaging; Joint Diseases - pathology; Joint Diseases - physiopathology; Joint surgery; Joints; Knee; Laboratories; Male; Medical sciences; Middle Aged; osteoarthritis; Osteoarthritis, Hip - diagnostic imaging; Pain - diagnostic imaging; Palpation; primary care; Range of Motion, Articular; Studies; Ultrasonic investigative techniques; Ultrasonography; Sonography; Human; Biochemical analysis; Radiodiagnosis; Effusion; Ultrasound imaging; Diseases of the osteoarticular system; Lower limb; Joint; Hip; Radiography; Symptomatology; Pain; Correlation analysis; Adult; Diagnosis; Technique
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.59.3.178

OBJECTIVE To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS Patients (n=224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a standardised examination. The distance between the ventral capsule and the femoral neck, an increase in which represents joint effusion, was measured sonographically. Joint effusion was defined in three different ways: “effusion” according to Koski's definition, “major effusion”, and “asymmetrical effusion” based on only individual side differences. RESULTS “Effusion” was present in 80 (38%), “major effusion” in 20 (9%), and “asymmetrical effusion” in 47 (22%) patients. Pain in the groin or medial thigh, pain aggravated by lying on the side, decreased extension/internal rotation/abduction/flexion, painful external rotation, and pain on palpation in the groin showed a significant relation (adjusted for age and radiological osteoarthritis of the hip) with ultrasonic hip joint effusion. “Major effusion” showed a significant relation with an increased ESR. When patients with bilateral pain and increased ESR were excluded, a side difference in the range of motion of extension of the hip was shown to be a good predictor for “asymmetrical effusion” (positive predictive value: 71%, negative predictive value: 80%). CONCLUSION This study showed a relatively high prevalence of ultrasonic joint effusion in adults with hip pain in general practice. Furthermore the results indicate a relation between joint effusion and clinical signs.