What is the diagnosis and recommended follow-up for a 63-year-old male presenting with left hip pain and radiographic evidence of osteoarthritis (OA) changes on hip X-ray, with no displaced fractures observed?

From the Guidelines

For a 63-year-old male with left hip pain and X-ray showing osteoarthritis without fracture, I recommend starting with conservative management, as this approach has been shown to be effective in managing osteoarthritis pain and improving quality of life 1. Begin with acetaminophen 1000mg three times daily or NSAIDs like ibuprofen 400-600mg three times daily with food (if no contraindications such as kidney disease, heart failure, or gastric ulcers). Combine this with physical therapy focusing on hip strengthening and range of motion exercises twice weekly for 6-8 weeks. Weight loss is advised if the patient is overweight. Use assistive devices like a cane held in the opposite hand for ambulation. Apply heat or ice packs for 15-20 minutes several times daily for pain relief. Some key points to consider in the management of hip osteoarthritis include:

• The use of radiographs as the first line of imaging to evaluate hip pain, as recommended by the American College of Radiology 1
• The consideration of MRI or CT scans if pain persists despite conservative management, to rule out occult fractures or other conditions not visible on X-ray 1
• The importance of a multimodal approach to managing osteoarthritis pain, including pharmacological and non-pharmacological interventions 1 If pain persists beyond 4-6 weeks despite these measures, follow up for the recommended CT scan to evaluate for subtle fractures or other pathology not visible on X-ray. Osteoarthritis pain often responds to this multimodal approach, addressing both inflammation and mechanical factors contributing to joint pain. The persistence of pain despite conservative management warrants further imaging as suggested in the X-ray report to rule out occult fractures or other conditions. It is also important to consider the patient's overall health and potential comorbidities when developing a treatment plan, as certain conditions may affect the choice of medications or other interventions 1.

From the Research

Diagnosis and Treatment of Osteoarthritis

• The patient's hip x-ray indicates osteoarthritis changes, which is consistent with the symptoms of hip pain, especially in a 63-year-old male 2.
• Osteoarthritis (OA) should be suspected in patients with pain in the fingers, shoulders, hips, knees, or ankles, especially if they are older than 40 years 2.
• Radiography can confirm the diagnosis and may be helpful before surgical referral, but findings generally do not correlate well with symptoms 2.

Management of Osteoarthritis

• The cornerstones of OA management include exercises, weight loss if appropriate, and education-complemented by topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) in those without contraindications 3.
• Intra-articular steroid injections provide short-term pain relief 3.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely recommended and prescribed to treat pain in osteoarthritis, but they have been associated with wide-ranging adverse events affecting the gastrointestinal, cardiovascular, and renal systems 4.
• IA NSAIDs may be an alternative therapy possibly minimizing systemic side effects while maintaining efficacy 5.

Treatment Options

• Joint replacement may be considered for patients with moderate to severe pain and radiographically confirmed OA 2.
• Corticosteroid injections may be helpful in the short term 2.
• IA NSAIDs had similar efficacy to PO NSAIDS and IA corticosteroids in treating OA-related pain; however, many trials did not have a placebo control and outcome measures were heterogeneous 5.
• Opiates should be avoided in the treatment of OA 3.

Follow-up

• If there is continued clinical concern or if the pain persists, a follow-up CT scan is recommended to further evaluate the patient's condition.