An 81-year-old woman presented to the orthopaedic clinic with progressive pain in her right hip over the past two years. She described the pain as dull and aching, worsening with activity, especially when walking or climbing stairs. She had also noticed stiffness in the hip joint, particularly in the morning or after sitting for long periods, which eased slightly with movement. Over the last few months, the pain had become more constant, affecting her sleep and limiting her daily activities, such as dressing and cooking.
On physical examination, the patient had a reduced range of motion in her right hip, with significant discomfort during internal rotation. There was no swelling or redness, but the patient had a noticeable limp when walking. An X-ray of the right hip showed joint space narrowing, osteophyte formation, and subchondral sclerosis, consistent
with advanced osteoarthritis.
The patient had a history of hypertension and mild osteoporosis but no prior history of hip injury or trauma. After discussing treatment options, the orthopaedic surgeon recommended conservative management, including nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief after checking that her creatinine level was normal,physical therapy to maintain joint function, and weight management to reduce stress on the joint. In the elderly, due to the risk of kidney failure and gastrointestinal bleeding with NSAIDs, makes paracetamol the first choice of pain relief for arthritis. If the symptoms continued to worsen, the possibility of hip replacement surgery would be considered. The patient was advised to return for follow-up in six months to assess her progress.