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New pain following total hip replacement — MSRA MCQ

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ModerateHip and GroinNew pain following total hip replacementMSRA

A 71-year-old woman presents with a 6-week history of gradually worsening deep right groin pain and a new limp. She had an uncomplicated right total hip replacement 5 years ago and had been walking independently without pain until this episode. She now struggles to put on shoes and can walk only 200 metres before stopping. There has been no fall, recent infection, fever, wound change, night sweats or weight loss. Examination shows an antalgic gait and pain on hip flexion and internal rotation. The scar is well healed, with no erythema, warmth or swelling. She is systemically well. What is the most appropriate next step in primary care?

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

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Correct answer: B — Refer to an orthopaedic surgical service for assessment

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

This patient has new, progressively worsening groin pain, limp and loss of function in a previously well-functioning total hip replacement. NICE recommends that primary care practitioners refer people who develop new or worsening pain, limp or loss of function related to a joint replacement to an orthopaedic surgical service. These features may indicate a prosthesis-related complication, such as aseptic loosening, wear, periprosthetic fracture or infection, and should not be managed as uncomplicated native-joint osteoarthritis. A is initially plausible because exercise-based rehabilitation is appropriate after joint replacement and for many non-specific hip presentations. However, new symptoms attributable to an established prosthesis require surgical assessment first. B may form part of specialist assessment, but obtaining radiography before referral should not delay the indicated referral. C risks delaying investigation of a potentially important implant-related complication; symptomatic treatment may be provided while awaiting assessment but is not the principal next step. E would be appropriate with features suggesting acute prosthetic joint infection or another emergency, such as fever, systemic illness, acute severe pain, wound inflammation or inability to bear weight. Those features are absent here.

Reference: Joint replacement (primary): hip, knee and shoulder — Recommendation 1.11.1: Referral from primary care (2020 (checked 15 August 2026)) — https://www.nice.org.uk/guidance/ng157/chapter/Recommendations