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Hip osteoarthritis — SCE Rheumatology MCQ

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ModerateOsteoarthritis and Soft Tissue RheumatologyHip osteoarthritisSCE Rheumatology

A 62-year-old woman is reviewed in a musculoskeletal interface clinic with radiographically confirmed right hip osteoarthritis. Despite 9 months of therapeutic exercise, weight-management support, use of a walking aid and an individualised analgesic strategy, she has daily pain, disturbed sleep and can no longer work or manage stairs independently. Her BMI is 41 kg/m². Type 2 diabetes and hypertension are adequately controlled, and she has no active infection or other specific contraindication to surgery. She would like to consider joint replacement. Her local referral template suggests deferring referral until her BMI is below 35 kg/m². What is the most appropriate next step?

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

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Correct answer: E — Refer now for orthopaedic assessment for total hip replacement

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

She should be referred now for consideration of total hip replacement. Her hip symptoms substantially impair quality of life and function, and appropriate non-surgical management has been ineffective. These are the NICE criteria for considering referral. Referral is based on clinical assessment and shared decision-making, not a mandatory numerical score or radiographic threshold. B is a plausible interpretation of some local pathways, and continued weight-management support remains appropriate, but obesity must not itself exclude or delay referral. Her individual perioperative risks should instead be assessed and discussed by the surgical team. C is attractive because intra-articular corticosteroid can provide short-term symptom relief when other measures are ineffective. However, failure of injection is not a prerequisite for referral, and it should not delay surgical assessment in someone already meeting referral criteria. D is incorrect because Oxford Hip Scores may describe symptom burden but should not determine eligibility for referral. E is incorrect because arthroscopic lavage or debridement should not be offered for osteoarthritis: it does not provide meaningful benefit and may cause harm.

Reference: Osteoarthritis in over 16s: diagnosis and management — Recommendations (19 October 2022) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations Osteoarthritis in over 16s: diagnosis and management — Rationale and impact (19 October 2022) — https://www.nice.org.uk/guidance/ng226/chapter/rationale-and-impact Osteoarthritis in over 16s: diagnosis and management — Intra-articular injections and arthroscopic procedures (19 October 2022) — https://www.nice.org.uk/guidance/NG226/chapter/recommendations