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Hip osteoarthritis — MSRA MCQ

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ModerateHip and GroinHip osteoarthritisMSRA

A 63-year-old man presents with an 18-month history of right groin pain that is worse on walking, climbing stairs and getting out of a car. Morning stiffness lasts around 10 minutes. He has no night sweats, fever, weight loss, recent trauma or neurological symptoms. Examination shows an antalgic gait and painful restriction of right hip internal rotation and flexion. He has completed a tailored therapeutic exercise programme and has engaged with weight-management support, but remains unable to walk his dog or work a full shift as a delivery driver. Topical NSAIDs were ineffective. Oral NSAIDs are unsuitable because of stage 3b chronic kidney disease and a previous NSAID-associated peptic ulcer bleed. An anteroposterior pelvic radiograph taken 6 months ago showed mild-to-moderate right hip osteoarthritis. He has a BMI of 38 kg/m² and smokes 10 cigarettes daily. He asks whether hip replacement can be considered. What is the most appropriate next step?

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

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Correct answer: B — Refer for consideration of hip joint replacement using clinical assessment of symptom impact and failed or unsuitable non-surgical management

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

This man has a clinical diagnosis of hip osteoarthritis: he is over 45 years old, has activity-related hip pain and brief morning stiffness. His symptoms now substantially impair quality of life, mobility and work. He has undertaken core non-surgical treatment, while further oral NSAID treatment is unsuitable because of renal impairment and previous NSAID-related gastrointestinal bleeding. NICE recommends considering referral for joint replacement when symptoms substantially affect quality of life and non-surgical management is ineffective or unsuitable. The decision should be based on clinical assessment rather than a numerical severity score or radiographic threshold. Smoking and obesity should prompt risk-reduction support, but neither BMI nor smoking status should exclude him from referral (B). Mild-to-moderate radiographic change does not preclude clinically important osteoarthritis, so repeat imaging to establish radiographic severity is unnecessary (C). Intra-articular corticosteroid injection can be considered for short-term relief or to facilitate exercise, but it is not a prerequisite to surgical referral in a patient whose non-surgical options are ineffective or unsuitable (D). NICE advises against strong opioids for osteoarthritis because harms outweigh benefits (E).

Reference: Osteoarthritis in over 16s: diagnosis and management (NG226) — Recommendations (Published 19 October 2022; checked 15 August 2026) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations Osteoarthritis in over 16s: diagnosis and management (NG226) — Referral for joint replacement (Published 19 October 2022; checked 15 August 2026) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations Osteoarthritis in over 16s: diagnosis and management (NG226) — Pharmacological management (Published 19 October 2022; checked 15 August 2026) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations