An article in the December 17, 2019 Journal of the American Medical Association (JAMA), highlighted the outcome of a systematic review designed to look at a rational clinical examination to identify the presence of a patient with hip osteoarthritis (OA). Studies were selected to assist in quantifying the accuracy of clinical findings while using standard radiographs as the reference for diagnosing hip OA. The best physical examination findings overall to identify patients most like to have OA are a squat maneuver causing posterior hip pain, groin pain with passive abduction or adduction, adductor weakness, and decreased passive hip adduction. These simple tests of hip motion and observation for pain during that motion were useful in identifying patients most likely to have OA on standard radiographs from those who won’t. In conclusion, this systematic review identified that a combination of findings can efficiently identify patient most likely to have severe hip OA.