Synopsis
Diagnose typical hip osteoarthritis clinically, recognise diagnoses that should not enter a routine degenerative pathway, quantify function and goals, deliver evidence-based non-operative care, and refer for replacement without inappropriate barriers.
- NICE supports a clinical diagnosis in people aged 45 or over with activity-related joint pain and no morning stiffness or stiffness lasting no longer than 30 minutes; routine imaging is unnecessary in a typical presentation.
- Localise groin, buttock and referred knee pain, test gait, flexion and internal rotation, examine both hips and distinguish spine, trochanteric and knee sources.
- Image when the presentation is atypical, rapidly progressive, traumatic, inflammatory or uncertain, or when radiographs are needed for surgical planning; severity on film does not equal symptom severity.
Key red flags
Fever, systemic illness, intense passive-movement pain or a recent bacteraemic source raises concern for septic arthritis and requires urgent aspiration and source-control assessment.
Investigation priorities
Diagnose a typical presentation and measure functional impact.
Management branches
The person is 45 or older with activity-related pain and absent or brief morning stiffness and no red flags.
- Explain the diagnosis and variable relationship between symptoms and structural change without ordering routine imaging.
- Prescribe tailored strengthening, aerobic and range exercise and address weight, gait aids and functional barriers.
Age, tempo, stiffness, examination or systemic findings do not fit routine osteoarthritis.
Key medicines
Oral NSAID with gastroprotection when appropriateIf a topical NSAID is ineffective or unsuitable, prescribe one oral NSAID at the lowest effective licensed adult dose for the shortest necessary period and co-prescribe a proton-pump inhibitor such as omeprazole 20 mg orally once daily while NSAID treatment continues when appropriate.
Intra-articular corticosteroidUse one image-guided intra-articular corticosteroid injection under the local hip-injection protocol when other pharmacological treatment is ineffective or unsuitable or a short analgesic window will support exercise; explain that benefit is usually short term, around 2 to 10 weeks.