How Should Hip Instability Be Clinically Diagnosed? Consensus Statements From a Scoping Review and an International...

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitation

Background:

• Atraumatic hip instability lacks standardized diagnostic criteria, hindering consistent clinical evaluation.
• A Delphi consensus study was conducted to address this diagnostic gap.
• International experts aimed to define standardized clinical statements for hip instability diagnosis.

Purpose of the Study:

• To identify typical presenting symptoms of hip instability.
• To determine optimal physical examination methods for assessing hip instability.
• To establish associated risk factors for symptomatic hip instability.

Main Methods:

• Modified Delphi technique employed with 100 international participants.
• Consensus meeting conducted during the 15th Symposium on Joint Preserving and Minimally Invasive Surgery of the Hip.
• Statements developed post-scoping review and voted on in two Delphi rounds with ≥75% agreement.

Main Results:

• Three physical examination tests achieved consensus: abduction-hyperextension-external rotation (AB-HEER), prone instability, and anterior apprehension (HEER).
• Consensus symptoms included anterior hip pain, mechanical symptoms (popping, clicking), and sensations of looseness.
• Female sex and hip dysplasia identified as key risk factors; younger age did not reach consensus.

Conclusions:

• A combination of physical exam tests, symptoms, and risk factors enhances diagnostic accuracy for hip instability.
• Standardized criteria improve reproducibility in clinical practice and research.
• Further research is needed to develop a comprehensive diagnostic framework.