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Hip osteoarthritis — MSRA MCQ

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ModerateHip and GroinHip osteoarthritisMSRA

A 52-year-old man presents with a 5-month history of gradually progressive right groin pain. It is worse after prolonged walking, climbing stairs and getting out of his van. Morning stiffness lasts around 15 minutes. He has no recent trauma, fever, night pain, weight loss, rash, back pain or other joint symptoms. He has a BMI of 32 kg/m². Examination shows a mildly antalgic gait and painful restriction of right hip internal rotation and flexion. There is no warmth, swelling, focal bony tenderness or neurological deficit. He asks whether he needs an X-ray before treatment can begin. What is the most appropriate initial management in primary care?

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

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Correct answer: B — Diagnose hip osteoarthritis clinically, provide information, and offer tailored therapeutic exercise with weight-management support without routine imaging

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

This presentation meets NICE criteria for a clinical diagnosis of osteoarthritis: he is aged over 45 years, has activity-related joint pain, and morning stiffness lasting no longer than 30 minutes. Painful restriction of hip internal rotation supports the hip as the symptomatic joint. There are no atypical features suggesting an alternative diagnosis, such as recent trauma, rapid progression, prolonged inflammatory stiffness, a hot swollen joint, infection or malignancy. Routine imaging is therefore not required before management begins. Core treatment is explanation and support, tailored therapeutic exercise, and weight management where appropriate. His BMI makes weight-management support relevant alongside exercise. A is attractive because pelvic radiography is commonly requested for hip pain, but it is not routinely indicated in a typical clinical presentation of osteoarthritis. B is premature because he has not yet had an adequate trial of non-surgical core treatment and his symptoms are not described as substantially impairing quality of life despite such treatment. D may be considered when pharmacological options are ineffective or unsuitable, or to facilitate exercise, but is not first-line here. E is inappropriate: MRI is not routinely needed, and strong opioids should not be offered for osteoarthritis.

Reference: Osteoarthritis in over 16s: diagnosis and management (NG226) — Recommendations (19 October 2022) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations Osteoarthritis in over 16s: diagnosis and management (NG226) — Recommendations (19 October 2022) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations Osteoarthritis in over 16s: diagnosis and management (NG226) — Recommendations (19 October 2022) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations