A 65-year-old man presents with a history of hip pain that is worse with activity, especially walking. On examination, there is reduced internal rotation of the hip. X-rays show joint space narrowing and osteophytes. What is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Hip fracture D) Avascular necrosis E) Trochanteric bursitis Correct Answer: A) Osteoarthritis Explanation: Osteoarthritis (OA) is the most common cause of hip pain in older adults, typically presenting with joint space narrowing and osteophytes on X-rays. The restriction of internal rotation is a hallmark of hip OA. Rheumatoid arthritis (B) would present with morning stiffness, symmetrical joint involvement, and erosions on X-ray, not typically with osteophytes. Hip fracture (C) would cause acute pain, often after trauma, with inability to bear weight. Avascular necrosis (D) presents with insidious pain, often after trauma or corticosteroid use, but typically involves the femoral head. Trochanteric bursitis (E) causes lateral hip pain, not pain with internal rotation, and would not show significant findings on X-ray. Key Tips for PLAB 1: ✅ Hip pain in elderly = Osteoarthritis ✅ Internal rotation = Reduced in hip OA ✅ Management = NSAIDs, physiotherapy, joint replacement if severe
