Coxartrosis Evaluation Guidelines

Clinical Evaluation

• The American College of Radiology suggests that the physical examination for coxartrosis should focus on evaluating the range of motion of the hip, especially the limitation of abduction and internal rotation, gait, the presence of pain on palpation of the greater trochanter, and the discrepancy in the length of the lower limbs 1
• The restriction of hip abduction is the most important finding, especially in patients over 3 months old, where the Ortolani and Barlow maneuvers lose sensitivity 1
• Observing if there is an antalgic gait (the patient shortens the support phase of the affected side) is crucial 1
• In bilateral cases, looking for a waddling gait (lateral swaying of the trunk) and increased lumbar lordosis is important 1
• Noting if the patient walks on tiptoes on the affected side to compensate for the pain is a significant finding 1
• Asymmetrical skin folds in the proximal thigh, although this sign has low specificity, can be an indicator 2
• Shortening of the lower limb on the affected side, evaluated with the patient in a supine position with the hips and knees flexed (Galeazzi sign), is a key sign 1
• The American College of Radiology recommends evaluating painful points in the gluteal region that may indicate compromise of the lumbar quadratus muscle 3
• The Ortolani maneuver, which involves abducting and gently lifting the flexed thigh while pushing the greater trochanter anteriorly, can indicate if the dislocated femoral head reduces into the acetabulum 1
• The Barlow maneuver, which involves gently adducting the thigh to attempt to dislocate the femoral head posteriorly, followed by abduction to relocate it, can detect capsular instability 1
• It is essential to note that these maneuvers are more useful in infants under 3 months for hip dysplasia, but in adults with suspected coxartrosis, limitation of movement is more relevant 1, 2
• Avoid confusing a stable "click" of the hip (without laxity) with true instability that requires follow-up 1
• Do not rely solely on asymmetrical skin folds as a diagnostic sign, as they have low specificity 2

Imaging Integration

• After 4-6 months of age (when the femoral ossification center appears), pelvic radiographs become more reliable 2
• In adults with a clinical suspicion of coxartrosis, a pelvic radiograph in a neutral position is the appropriate initial study 2