Questionnaire/history: 45+ years? Activity-related joint pain, which has developed over months or years? No morning joint-related stiffness or morning stiffness lasting no longer than 30 min? Stiffness? Pain history: - Location? ----- Deep pain in the anterior groin on walking or climbing stairs? ----- Referred pain to: ----------- Lateral thigh? ----------- Buttock? ----------- Anterior thigh, knee, and ankle? - Onset? - Duration? ------ At rest? ------ Disturbing sleep? - Progression? - Pattern? - Severity of symptoms? Risk factor for osteoarthritis? Trauma? Systemic symptoms? Functional impairment? Psychosocial impact? Tried self-help strategies and treatments? Fall risk? Past medical history (eg chronic pain syndrome, obesity)? Family history (eg osteoarthritis or joint problems)? Current medication? Drug allergies? Social support? Examination: Height? Weight? BMI? Antalgic gait with a lurch towards the affected hip with less time spent weight-bearing on that side? Trendelenburg gait - a lurch towards the affected hip with less time spent weight-bearing on that side and the pelvis tilting down on the unaffected side, caused by wasting and weakness of the gluteal and anterior thigh muscles? Bony swelling and joint deformity? - Fixed flexion external rotation deformity, with compensatory increased lumbar lordosis and pelvic tilt? - Lower limb shortened? Joint warmth and/or tenderness (there may be synovitis)? Muscle wasting and weakness? Restricted and painful range of joint movement? - Painful restriction of internal rotation with the hip flexed? Crepitus (a grating sound or sensation produced by friction between bone and cartilage)? Joint instability? Management: Advised: - Paracetamol and/or topical ibuprofen and if ineffective oral ibuprofen +/- codeine - Capsaicin prn - Local heat or cold packs - Appropriate footwear - Local muscle strengthening exercise and aerobic fitness training - To lose weight if overweight or obese - Psychological support options - Adjustments to home and/or work if needed - Sources of information and support: ----- Versus Arthritis ----- Arthritis and Musculoskeletal Alliance (ARMA) ----- NHS Health A to Z: Osteoarthritis ----- Patient UK: Osteoarthritis - Review prn Reference(s): NICE CKS: Osteoarthritis Information for parents/carers: Arthritis and Musculoskeletal Alliance (ARMA) NHS Health A to Z: Osteoarthritis Patient UK: Osteoarthritis British Society for Surgery of the Hand (BSSH): Arthritis at the base of the thumb Versus Arthritis