PMID- 28203594
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2325-9671 (Print)
IS  - 2325-9671 (Electronic)
IS  - 2325-9671 (Linking)
VI  - 5
IP  - 1
DP  - 2017 Jan
TI  - Foot Progression Angle Walking Test: A Dynamic Diagnostic Assessment for 
      Femoroacetabular Impingement and Hip Instability.
PG  - 2325967116679641
LID - 10.1177/2325967116679641 [doi]
LID - 2325967116679641
AB  - BACKGROUND: Determining an accurate clinical diagnosis for nonarthritic hip pain 
      may be challenging, as symptoms related to femoroacetabular impingement (FAI) or 
      hip instability can be difficult to elucidate with current testing methods. In 
      addition, commonly utilized physical examination maneuvers are static and do not 
      include a dynamic or weightbearing assessment to reproduce activity-related 
      symptoms. Therefore, implementing a dynamic assessment for FAI and hip 
      instability could help to improve diagnostic accuracy for routine clinical 
      examinations of patients with nonarthritic hip pain. PURPOSE: To assess the 
      efficacy of a novel diagnostic foot progression angle walking (FPAW) test for 
      identifying hip pathology related to FAI or hip instability. STUDY DESIGN: 
      Prospective cohort study; Level of evidence, 3. METHODS: This prospective study 
      included 199 consecutive patients who were evaluated for unilateral hip pain and 
      who underwent FPAW testing along with standard physical examination testing. 
      Demographic data, including age, sex and hip laterality, were collected from each 
      patient. FPAW testing was performed with directed internal and external foot 
      progression angles from their baseline measurements, with a positive test 
      reproducing pain and/or discomfort. Comparisons were then made with flexion 
      adduction internal rotation (FADIR) and flexion abduction external rotation 
      (FABER) tests as the designated diagnostic standard examinations for FAI and hip 
      instability, respectively. Sensitivity and specificity, along with the McNemar 
      chi-square test for group comparison, were used to generate summary statistics. 
      In addition, areas under the combined receiver operating characteristic curves 
      (AUC) of test performance were calculated for both FPAW and the designated 
      standard examination tests (FADIR, FABER). Radiographic imaging was used 
      subsequently to confirm the diagnosis. RESULTS: The average age of the study 
      cohort was 35.4 +/- 11.8 years, with 114 patients being female (57%). Positive 
      internal FPAW testing demonstrated 61% sensitivity and 56% specificity for an FAI 
      diagnosis, compared with the 96% sensitivity and 11% specificity seen with FADIR 
      testing. Internal FPAW was less sensitive, yet more specific compared with FADIR 
      (P < .001). Combined testing had improved accuracy (AUC = 0.58; P < .05) compared 
      with FADIR (AUC = 0.52; P = .21) or FPAW (AUC = 0.57; P = .057) alone. Positive 
      external FPAW revealed 67% sensitivity and 70% specificity for hip instability, 
      while FABER testing was 54% sensitive and 90% specific. External FPAW was 
      significantly more specific but had similar sensitivity to FABER. Combined 
      testing had greater accuracy (AUC = 0.77) compared with FABER (AUC = 0.70) or 
      FPAW (AUC = 0.67) alone (P < .001). CONCLUSION: The FPAW examination can be used 
      as an adjunct examination to assist and improve the accuracy of the clinical 
      diagnosis for FAI and hip instability.
FAU - Ranawat, Anil S
AU  - Ranawat AS
AD  - Center for Hip Preservation, Hospital for Special Surgery, New York, New York, 
      USA.
FAU - Gaudiani, Michael A
AU  - Gaudiani MA
AD  - Center for Hip Preservation, Hospital for Special Surgery, New York, New York, 
      USA.
FAU - Slullitel, Pablo A
AU  - Slullitel PA
AD  - Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, 
      Buenos Aries, Argentina.
FAU - Satalich, James
AU  - Satalich J
AD  - Center for Hip Preservation, Hospital for Special Surgery, New York, New York, 
      USA.
FAU - Rebolledo, Brian J
AU  - Rebolledo BJ
AD  - Department of Orthopaedic Surgery, Stanford University, Redwood City, California, 
      USA.
LA  - eng
PT  - Journal Article
DEP - 20170110
PL  - United States
TA  - Orthop J Sports Med
JT  - Orthopaedic journal of sports medicine
JID - 101620522
PMC - PMC5298398
OTO - NOTNLM
OT  - clinical diagnosis
OT  - femoroacetabular impingement
OT  - hip dysplasia
OT  - hip instability
COIS- One or more of the authors has declared the following potential conflict of 
      interest or source of funding: A.S.R. is a paid consultant for Arthrex Inc, 
      CONMED Linvatec, DePuy Mitek, and Stryer MAKO and receives IP royalties from 
      ConforMIS.
EDAT- 2017/02/17 06:00
MHDA- 2017/02/17 06:01
PMCR- 2017/01/10
CRDT- 2017/02/17 06:00
PHST- 2017/02/17 06:00 [entrez]
PHST- 2017/02/17 06:00 [pubmed]
PHST- 2017/02/17 06:01 [medline]
PHST- 2017/01/10 00:00 [pmc-release]
AID - 10.1177_2325967116679641 [pii]
AID - 10.1177/2325967116679641 [doi]
PST - epublish
SO  - Orthop J Sports Med. 2017 Jan 10;5(1):2325967116679641. doi: 
      10.1177/2325967116679641. eCollection 2017 Jan.