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Hip osteoarthritis — MSRA MCQ

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HardHip and GroinHip osteoarthritisMSRA

A 69-year-old woman presents with 4 months of gradually progressive right groin pain. It is worse on walking and rising from a chair, and she has brief stiffness after sitting but no prolonged morning stiffness, fever, trauma or systemic symptoms. Examination shows painful restriction of internal rotation and flexion. She has no neurological deficit and can weight-bear. The clinical diagnosis is hip osteoarthritis. She has started a tailored physiotherapy programme, but pain prevents her from completing strengthening exercises. Paracetamol and topical ibuprofen have provided little benefit. Oral NSAIDs are unsuitable because she has stage 3b chronic kidney disease and previously had an NSAID-associated upper gastrointestinal bleed. She asks whether stronger analgesia or an injection would help. What is the most appropriate next management step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Arrange an intra-articular corticosteroid injection to facilitate therapeutic exercise

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

This is clinically typical hip osteoarthritis, with no feature suggesting fracture, inflammatory arthritis, infection or malignancy. Her pain is now preventing participation in the core treatment of therapeutic exercise. Oral NSAIDs are unsuitable because of both renal impairment and previous NSAID-associated gastrointestinal bleeding. NICE advises considering an intra-articular corticosteroid injection when other pharmacological treatments are ineffective or unsuitable, including to support therapeutic exercise. She should be counselled that benefit is short term, typically 2 to 10 weeks. A is incorrect because routine imaging is not recommended to guide non-surgical osteoarthritis management once the diagnosis is clinically secure. B is inappropriate because NICE advises against strong opioids for osteoarthritis: their harms outweigh benefits. D is incorrect because intra-articular hyaluronan injections should not be offered. E may become appropriate if symptoms substantially impair quality of life and non-surgical management proves ineffective or unsuitable, but this patient has not yet had a reasonable opportunity to undertake exercise with adequate symptom support.

Reference: Osteoarthritis in over 16s: diagnosis and management — Recommendations (October 2022) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations Osteoarthritis in over 16s: diagnosis and management — Recommendations (October 2022) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations