Groin pain - Suspected osteoarthritis of the hip

Osteoarthritis of the hip becomes more prevalent with age. In 2016 10.9% of people over the age of 45 living within NHS Ayrshire and Arran had been diagnosed with hip osteoarthritis with 3% being classified with severe symptoms. (Versus Arthritis, 2016).

Though X rays can be used to categorise hip osteoarthritis into Early, mild, moderate or severe presentations. Radiological indication of femoro-acetabular impingement (FAI) should be considered as part of the osteoarthritic process and does not necessitate a referral to Orthopaedics unless the patient has significant
symptoms.

Often patients’ symptoms of hip pain can be treated with advice on activity modification and graded strengthening exercises within primary care. Referral to MSK can be considered if self- management exercises for mild/ moderate hip OA have failed to improve symptoms.

Referral to Orthopaedics for consideration of total hip replacement (THR) should only be considered if 3 months of strengthening exercises have been undertaken without improvement.

• Mechanism of onset, location of symptoms, severity and longevity of symptoms
• Limitation to function
• Difficulty reaching foot/ putting sock on.

1. Limited hip movements of flexion, abduction and internal rotation
2. Pain on single leg standing.

Hip X-ray.

• Lumbar spine/ radiculopathy
• Soft tissue injury groin pain (consider MSK)
• Hernia/ Gilmores Groin

• Pain relief in line with agreed formularies/guidance
• Patient education, activity modification – Versus Arthritis. Osteoarthritis of the hip factsheet
• NHS AAA MSK website
• Patient information leaflet - NHS Inform. Osteoarthritis of the hip.

Diagnostically uncertain.
Symptoms persist beyond 2- 3/12 and interfere with ADLs despite conservative management.
If X ray reported as moderate/ severe and pain limiting ADLs significantly then consider referral to Orthopaedics.