Introduction
- Wash hands (and don PPE if needed)
- Introduce yourself (name and role)
- Confirm patient’s name and DOB
- Explain what the examination involves
- Gain consent to continue
- Ask the patient if they’ve had a hip replacement
- Expose the patients legs
- Position the patient standing
- Ask if patient in any pain before continuing
General Inspection
Clinical Signs
- Body habitus
- Scars
- Wasting of muscles
Objects and Equipment
- Walking aids
- Prescriptions
Closer inspection
- Look in all planes
- Quads wasting
- Leg length discrepancy
- Pelvic tilt
- All the other stuff
Gait
Walk to the end of the room and turn back
- Gait cycle and ROM
- Limping
- Leg length
- Turning
- Trendelenberg gait - unilateral weakness of the hip abductor secondary to superior gluteal nerve lesion
- Waddling gait - bilateral weakness of hip abductor muscles associated with myopathies
Reposition the patient to lying at 45 on the bed
Inspect on the bed
- DWASS
Feel
Temperature
- Assess and compare
Hip Joint Palpation
- Palpate the greater trochanter of each leg for tenderness - trochanteric bursitis
Leg length assessment
To differentiate any weird pelvic tilts/involvement from leg problems
Apparent leg length
- Measure and compare the distance between the umbilicus and tip of medial malleolus
True leg length
- Measure from the anterior superior iliac spine to the tip of the medial malleolus
Move
Active movement
- Hip flexion
- Hip extension
Passive movement
- Hip flexion
- Hip extension - ask the patient to lie in a prone position to get full ROM
- Hip internal rotation
- Hip external rotation
- Hip abudction
- Hip adduction
Special tests
Thomas’s test
Should not be performed on patients with a hip replacement Used to assess for fixed flexion deformity
- With the patient flat on the bed, place a hand below their lumbar spine with palm facing upwards
- Passively flex the hip of the unaffected leg as far as you can and observe the contralateral limb.
- Repeat with the other limb The test is positive if the affected thigh raises off the bed indicating a fixed flexion deformity
Trendelenburg’s test
To test for hip abductor weakness.
- Get the patient to stand
- Position fingers on each side of patients pelvis at iliac crest
- Ask the patient to stand on one leg and observe fingers for a tilt
- Repeat on the other leg
To Complete the Exam
- Explain to the patient that the examination is now finished.
- Thank the patient for their time.
- Dispose of PPE appropriately and wash your hands.
- Summarise your findings.