The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip

R. Altman*, G. Alarcón, D. Appelrouth, D. Bloch, D. Borenstein, K. Brandt, C. Brown, T. D. Cooke, W. Daniel, D. Feldman, R. Greenwald, M. Hochberg, D. Howell, R. Ike, P. Kapila, D. Kaplan, W. Koopman, C. Marino, E. McDonald, D. J. McShaneT. Medsger, B. Michel, W. A. Murphy, T. Osial, R. Ramsey‐Goldman, B. Rothschild, F. Wolfe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1646 Scopus citations


Clinical criteria for the classification of patients with hip pain associated with osteoarthritis (OA) were developed through a multicenter study. Data from 201 patients who had experienced hip pain for most days of the prior month were analyzed. The comparison group of patients had other causes of hip pain, such as rheumatoid arthritis or spondylarthropathy. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop different sets of criteria to serve different investigative purposes. Multivariate methods included the traditional “number of criteria present” format and “classification tree” techniques. Clinical criteria: A classification tree was developed, without radiographs, for clinical and laboratory criteria or for clinical criteria alone. A patient was classified as having hip OA if pain was present in combination with either 1) hip internal rotation ≥15º, pain present on internal rotation of the hip, morning stiffness of the hip for ≤60 minutes, and age >50 years, or 2) hip internal rotation <15º and an erythrocyte sedimentation rate (ESR) ≤45 mm/hour; if no ESR was obtained, hip flexion ≤115º was substituted (sensitivity 86%; specificity 75%). Clinical plus radiographic criteria: The traditional format combined pain with at least 2 of the following 3 criteria: osteophytes (femoral or acetabular), joint space narrowing (superior, axial, and/or medial), and ESR <20 mm/hour (sensitivity 89%; specificity 91%). The radiographic presence of osteophytes best separated OA patients and controls by the classification tree method (sensitivity 89%; specificity 91%). The “number of criteria present” format yielded criteria and levels of sensitivity and specificity similar to those of the classification tree for the combined clinical and radiographic criteria set. For the clinical criteria set, the classification tree provided much greater specificity. The value of the radiographic presence of an ostophyte in separating patients with OA of the hip from those with hip pain of other causes is emphasized.

Original languageEnglish (US)
Pages (from-to)505-514
Number of pages10
JournalArthritis & Rheumatism
Issue number5
StatePublished - May 1991

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Immunology and Allergy
  • Rheumatology
  • Immunology


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