You evaluate a 66-year-old patient with groin pain accentuated by prolonged standing a few days a month. A plain radiograph of the hips shows narrowing of the femoroacetabular joint space, sclerosis and osteophytes. What is your approach?
We are talking about a 66-year-old patient with pain on some days, pain of an occasional nature. Although the diagnosis is clearly osteoarthritis, it does not lead directly to a surgical indication. The first step is to try conservative treatment (we ruled out the first option). Osteoarthritis is a degenerative process that opioids certainly do not stop, so we rule out option two. Option four can also be quickly discarded: the statement makes the diagnosis and treatment to follow clear: in this case the MRI will not provide us with any information of interest.
I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis.
Start treatment with weak opioids that have shown evidence in stopping the progression of the disease.
I insist treatment with paracetamol, explain that the evolution is very variable and the surgical indication depends on the functionality and pain control.
Because of the radiological features described, I need a hip MRI before making a therapeutic decision.
The first step is to try conservative treatment (we ruled out the first option).
Osteoarthritis is a degenerative process that opioids certainly do not stop, so we rule out option two.
The first step is to try conservative treatment (we ruled out the first option).
Option four can also be quickly discarded: the statement makes the diagnosis and treatment to follow clear: in this case the MRI will not provide us with any information of interest.