The Hip Drop Physical Examination Test Can Be Used to Guide Advanced Imaging and Surgical Decision Making

Area of Science:

• Orthopaedic Surgery
• Sports Medicine
• Diagnostic Imaging

Background:

• Hip abductor tendon tears are a common cause of lateral hip pain.
• Accurate diagnosis is crucial for appropriate treatment and patient outcomes.
• The hip drop test (HDT) is a clinical maneuver used to assess for these tears.

Purpose of the Study:

• To evaluate the clinical utility of the HDT in diagnosing hip abductor tendon tears.
• To determine the HDT's ability to predict future surgical intervention.
• To identify patient risk factors associated with hip abductor tendon tears and subsequent surgery.

Main Methods:

• Retrospective review of 261 patients (aged 18+) with suspected hip abductor tendon tears and documented HDT results.
• Hip magnetic resonance imaging (MRI) served as the gold standard for diagnosis.
• Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated; logistic regression was used to analyze risk factors.

Main Results:

• The HDT demonstrated high specificity (99.1%) and NPV (86.9%) for diagnosing hip abductor tendon tears via MRI.
• For predicting future surgery, the HDT showed high specificity (96.8%) and NPV (99.2%).
• Positive HDT results had an 87.5% PPV for tear diagnosis and a 50.0% PPV for predicting surgery.

Conclusions:

• The HDT is a valuable clinical tool for diagnosing hip abductor tendon tears in patients with lateral hip pain, especially when performed by experienced clinicians.
• A negative HDT result has a high NPV, suggesting patients may forgo immediate advanced imaging and consider nonoperative management.
• Risk factors for tears include female sex, older age, and higher BMI, warranting increased suspicion for advanced imaging and potential surgery.