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Arthrose de la hanche

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À propos de l'arthrose de la hanche

Hip osteoarthritis (OA) is is a condition of the whole hip joint that can be associated with pain, stiffness, reduced mobility and difficulty with daily activities. Symptoms can vary over time and do not inevitably worsen (NICE 2022).

Symptoms commonly include activity-related groin or hip pain, sometimes felt in the thigh or knee, and painful or restricted hip movement, especially internal rotation and flexion (Koc et al. 2025).

Scope: this pathway supports conservative assessment and care for adults with a clinical presentation consistent with hip OA after appropriate safety screening. It does not cover suspected fracture, infection, malignancy, osteonecrosis, inflammatory arthritis, a primarily non-arthritic hip disorder, post-operative rehabilitation or people under 18. Arrange referral or shared care when needs fall outside this scope.

À propos des parcours de soins du CCG

Objectif

CCG is a knowledge translation resource of the Canadian Chiropractic Association. Its care pathways help chiropractors and other clinicians organize conservative care for musculoskeletal conditions. Each pathway outlines the main steps of the clinical encounter and supports decisions about assessment, care, monitoring, referral, co-management, and discharge. The pathways provide a structured approach to care, not a fixed prescription.

Développement

Pathways draw on relevant clinical practice guidelines, systematic reviews, peer-reviewed literature, and safety or professional sources. These sources inform, but do not determine, pathway content. Their findings reflect the questions, populations, outcomes, methods, and judgments used and may not apply to every person. Condition-specific sources are identified by author or organization and year, with full citations in one reference list at the end of the pathway.

Principles of Care

Musculoskeletal conditions are shaped by physical, psychological, social, cultural, and environmental factors, so no single approach fits everyone. Good care is ethical, evidence-informed, person-centred, culturally responsive, and tailored to the patient’s goals, preferences, circumstances, and response. Shared decision-making and informed consent guide care. Education, active rehabilitation, and self-management support recovery, functioning, participation, and long-term health. Regular reassessment shows whether the plan is helping and when to continue, adapt, stop, refer, co-manage, or discharge.populations.

Pathway Flow at a Glance

The pathway follows a recurring clinical cycle: understand the person and their goals; screen for safety and referral needs; develop a working clinical profile; agree on a plan and relevant outcomes; provide care; reassess response and safety; and continue, adapt, stop, refer, co-manage, or discharge as appropriate.

Avis de non-responsabilité

CCG care pathways support professional clinical judgment; they do not replace it or the advice of a qualified provider. They are not prescriptive, authoritative, or regulatory and are not intended for diagnosis or billing. Clinicians remain responsible for practicing within their competence and scope, meeting applicable legal and regulatory requirements, obtaining informed consent, recognizing emergencies, and arranging referral or co-management when needed.

Parcours de soins pour l'arthrose de la hanche

1. Tenue des registres

Accurate, timely, and sufficiently detailed documentation supports safe, high-quality care. The record should reflect clinically relevant patient interactions, clinical reasoning, decisions, care provided, and progress over time. Documentation should meet the legal, regulatory, privacy, retention, and organizational requirements that apply where the clinician practices. A structured format, such as SOAP, may support consistency, clarity, and continuity and can be adapted to the encounter and practice setting.

Subjectif : Record the patient’s concerns, symptoms, functioning and participation, goals, preferences, relevant history and context, and response or adverse effects from previous care.

Objectif: Record relevant examination findings, outcome measures, diagnostic test results when available, and clinically important changes.

Évaluation: Record the clinical interpretation of findings, working diagnosis or clinical profile, differential and safety considerations, relevant risk factors or modifiers, and the patient’s progress or response.

Planifier: Record care provided or proposed, education and self-management, consent and patient decisions, changes to the plan, agreed outcomes and reassessment point, referrals or co-management, follow-up, and discharge planning.

Document at the time of the encounter or as soon as practicable. Corrections and additions should preserve the integrity of the record. Clear records support patient safety, shared decision-making, communication, continuity, and accountability.

2. Consentement éclairé
  • Définition: A continuing process in which a capable patient, or an authorized substitute decision-maker when required, voluntarily agrees to a proposed examination or intervention after receiving and understanding the information needed to make an informed choice.
  • Aspects clés :
    • Avant l'interaction : Obtain consent before beginning an examination, procedure, or treatment, except where applicable law permits otherwise. Explain what is proposed and why. Revisit consent when the plan or material information changes.
    • Volontairement et spécifiquement : must be voluntary and specific to the proposed care. Consider the patient’s capacity for the decision at the time it is required and follow applicable requirements for substitute decision-making when the patient lacks capacity. The patient may ask questions, refuse, place limits on, or withdraw consent.
    • Processus transparent : Use honest, plain, and accessible communication. Offer interpretation or other communication support when needed and consider language, culture, health literacy, disability, and prior trauma. Written or digital information may support but does not replace discussion.
    • Compréhension et entente du patient :
      • Diagnostic/pronostic : Explain relevant findings, the clinical impression or working diagnosis, important uncertainty, and the expected course in understandable language.
      • Plan de traitement : Discuss the nature and purpose of proposed care, expected benefits, material risks and side effects, burdens, reasonable alternatives, the option of no intervention, and the likely consequences of accepting or declining.
      • Questions : Invite questions, explore goals and preferences, allow appropriate time for a decision, and confirm understanding, for example using teach-back.
    • Documentation : Record the consent discussion and decision, including material information provided, questions, capacity or substitute decision-maker where relevant, consent, refusal, limits or withdrawal, and any need to revisit consent. Follow documentation requirements applicable to the jurisdiction and practice setting.
3. Historique médical
  • Use culturally safe, trauma- and violence-informed care. Explain why questions matter, seek permission before sensitive topics, and adapt communication to the patient’s language, identity, culture, disability and previous health care experiences (Public Health Agency of Canada 2018).
  • Patient and contextual information: age; sex and gender when clinically relevant; preferred language and communication needs; work or school; caregiving; mobility and transportation; and the activities, roles, cultural practices and community connections important to the patient.

Primary Concerns

  • Context and onset: gradual or sudden onset; recent or remote trauma; first episode or recurrence; previous hip or lower-limb injury; childhood or developmental hip disorder; surgery; and whether symptoms are improving, stable, fluctuating or worsening.
    • Location and pattern: groin, anterior, lateral or posterior hip symptoms; thigh or knee referral; duration, intensity, irritability, stiffness and pattern through the day and night.
    • Aggravating and relieving factors: walking, stairs, rising from a chair, squatting, dressing, getting in or out of a vehicle, lying on the hip, prolonged positions, loading, movement and rest.
    • Associated symptoms and participation: locking or giving way; swelling, heat or redness; back or leg symptoms; numbness or weakness; fever or systemic illness; falls; and effects on sleep, self-care, work, school, driving, caregiving, recreation and community participation.
  • Revue des systèmes corporels : select relevant neurological, cardiovascular and vascular, gastrointestinal, genitourinary, rheumatological, infectious and constitutional questions based on the presentation.
  • Health, lifestyle and history: other joint symptoms or OA; inflammatory disease; osteoporosis or fracture risk; cancer or infection history; diabetes and cardiovascular health; previous hip injury or developmental disorder; hospitalizations and surgeries; medicines and supplements, including corticosteroids, anticoagulants and current pain medicines when relevant; physical activity, sleep, smoking, alcohol and substance use.
  • Social and access context: consider work or school demands and supports, caregiving, income, housing, food security, transportation, discrimination, safety, social support, access to care and culturally relevant or community supports when these may shape health, care or participation (Public Health Agency of Canada 2026).
  • Soins et interventions antérieurs : advice, exercise, hands-on care, medication, injection, walking aid, weight-management support or other self-management tried; what helped or did not help; adverse effects; and reasons care was difficult to use or continue.
  • Patient perspective: understanding of the problem, priorities, preferences, cultural context, concerns, expectations, confidence, strengths, previous experiences of care and interest in discussing medical or surgical options.
  • Flag review: check Red Flags and use the fixed Orange Flags and Yellow Flags sections when relevant.

Outcome measures

  • Use a small set of measures that are meaningful to the patient and practical to repeat. Record a baseline and reassess often enough to guide decisions (Koc et al. 2025).
  • Patient-specific functioning: Patient-Specific Functional Scale (PSFS).
  • Disability and participation: WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).
  • Reprise: Usage Échelles d'auto-évaluation du rétablissement.
  • Qualité de vie : the patient’s own rating or a validated measure suitable for the setting, such as WHOQOL-BREF.
  • Additional measures: a validated hip-specific symptom and functioning measure, pain impact or interference, perceived recovery, sleep or role participation, and a relevant physical performance task such as walking, chair rise, stairs or balance when the result will inform care.
  • Objectifs individuels : agree on patient-defined goals and how progress will be recognized.
4. Red Flags : Possible Serious Conditions and Other Causes of Hip Pain

Red flags are prompts for clinical reasoning, not diagnoses on their own. Interpret the whole presentation, new change and combination of findings, and use clinical judgement. Atypical features include recent trauma, prolonged morning stiffness, rapid worsening, deformity, a hot swollen joint, or concern about infection or malignancy.

ACTION: Arrange emergency assessment immediately:

  • Major trauma or suspected unstable hip fracture or dislocation: severe pain after trauma, deformity, a shortened or rotated leg, inability to bear weight, or neurological or circulatory compromise. Hip fracture cannot be reliably excluded by physical examination alone. (ACR Acute Hip Pain 2024 Update).
  • Septic arthritis with systemic illness or rapid deterioration: acute severe joint pain with marked loss of movement or weight-bearing, a hot or swollen joint, fever, chills, sepsis, altered mental status or another sign of instability. Fever can be absent, and clinical findings alone cannot confirm or exclude infection. (Ravn et al. 2023).
  • Cauda equina syndrome or rapidly progressive neurological compromise: new difficulty initiating urination, urinary retention or overflow, altered saddle or genital sensation, new bowel control or sexual dysfunction, or severe or progressive bilateral leg weakness or sensory change. Do not delay referral to complete testing in the clinic. (GIRFT 2026).

ACTION: Arrange prompt medical assessment:

  • Occult, fragility or stress fracture: new focal hip or groin pain after minor trauma or repetitive loading, marked difficulty bearing weight, persistent pain after trauma, osteoporosis, previous fragility fracture, prolonged systemic corticosteroid exposure or another major bone-health risk. (ACR Acute Hip Pain 2024 Update).
  • Possible joint infection without current systemic instability: a painful hot or swollen joint, rapid loss of movement, fever or chills, recent infection, surgery or joint injection, immunosuppression, injection drug use or bloodstream-infection risk. (Ravn et al. 2023).
  • Malignancy or another bone lesion: past or current cancer, unexplained persistent or progressive pain, night pain, unexplained weight loss or general decline, focal bony tenderness, an enlarging mass or an unexplained fracture. (NICE 2023; NICE 2026).
  • Osteonecrosis of the femoral head: unexplained progressive hip or groin pain with relevant risks such as previous trauma, systemic corticosteroid exposure, substantial alcohol exposure, blood disorders, chemotherapy or radiation. A risk factor is not diagnostic on its own. (ACR Osteonecrosis 2022 Update).
  • Arthrite inflammatoire : prolonged morning stiffness, night waking with improvement on movement, a hot or swollen joint, multiple joint symptoms, or associated psoriasis, inflammatory bowel disease, uveitis, enthesitis or dactylitis. (NICE 2017).
  • A non-hip or overlapping condition: neurological findings or a symptom pattern that points to the lumbar spine, peripheral nerve, pelvis, abdomen, genitourinary system, hernia, vascular system or another regional source. (ACR Chronic Hip Pain 2022 Update).

ACTION: Arrange planned referral or shared care when:

  • The presentation is atypical, uncertain or outside scope: symptoms do not fit a typical hip OA presentation, the clinical impression remains uncertain, marked functional loss persists, or another professional is needed for diagnosis, medication, injection, rehabilitation, psychosocial support or other care.
  • Joint replacement assessment is relevant to the patient’s goals: hip symptoms and functional limitations substantially affect quality of life and acceptable non-surgical options are ineffective or unsuitable. Base referral on clinical assessment rather than a numerical score, and do not use age, sex, gender, smoking, comorbidity or body mass index alone to exclude referral. (NICE 2022).
  • Provide safety-net advice about new or worsening inability to bear weight, trauma, fever or systemic illness, neurological change, bowel or bladder symptoms, rapidly increasing pain or another change that requires earlier reassessment or emergency care. Document findings, actions, advice and follow-through.
5. Signaux d'alerte (drapeaux orange) : Symptômes de troubles psychiatriques nécessitant une orientation vers un spécialiste

Orange Flags are signs that a mental health or substance use concern may require emergency or timely assessment or shared care, and may change whether and how MSK care proceeds. They are not diagnoses. Ask directly and respectfully when concern arises, considering immediate safety, severity, change from usual, daily functioning and context. Psychosocial factors that may affect recovery but do not require separate mental health or medical assessment are addressed under Yellow Flags.

ACTION: Arrange emergency assessment now when there is immediate danger or an urgent medical need:

  • Suicide, self-harm or harm to others: current intent or plan, a recent attempt, inability to stay safe, or behaviour suggesting an immediate risk of serious harm.
  • Severe change in mental state: extreme agitation, confusion, disorganization, possible psychosis or mania with impaired judgment or unsafe behaviour, or inability to meet basic needs when this creates immediate danger.
  • Substance-related or medical emergency: suspected overdose, severe intoxication, dangerous withdrawal, delirium or another sudden change requiring urgent medical care.

When immediate safety is uncertain, do not leave the person alone while help is arranged. Follow local emergency procedures and call 9-1-1 for immediate danger or urgent medical need. If the person is thinking about suicide, call or text 9-8-8: Suicide Crisis Helpline with them or support them to do so.

If violence, abuse or exploitation is disclosed or suspected, support immediate safety and follow applicable safety and reporting requirements.

ACTION: Arrange prompt medical or mental health assessment when there is:

  • Suicide or self-harm thoughts: thoughts without immediate danger.
  • Substantial symptoms or effects: severe, persistent or worsening symptoms of depression, anxiety, trauma, possible psychosis or mania, eating problems or substance use that substantially affect daily life, decision-making or safe participation in care.
  • Other reasons for assessment: a marked change from usual behaviour or functioning; concern about medication or substance effects; a presentation outside the clinician’s competence; or a request for help.

Agree with the patient on who will be contacted, how soon and what to do if the situation worsens. Confirm that the person has connected with the service when clinically important.

ACTION: Adapt and coordinate MSK care:

  • Safe care: care may continue when it is safe and acceptable and does not delay needed assessment. Adapt communication, examination and care; obtain ongoing consent; and coordinate with other providers with the patient’s permission.
  • Continue the MSK assessment: do not assume that a mental health or substance use concern explains the MSK presentation. Continue to consider physical causes and the patient’s account.
  • Questionnaires: they may support conversation and monitoring, but do not establish a diagnosis or replace direct questions, clinical judgment or action.
  • Acceptable support: ask what type of help is acceptable and whether language, cultural, family, community or other supports are important to the patient.

ACTION: Document and follow up:

Record the concern; relevant questions and the patient’s responses; the safety decision and reasons; actions, advice and referrals; communication and consent; follow-up; and any unresolved concern. Follow applicable privacy, safety and reporting requirements.

For provincial, territorial and national services, see Mental health support: Get help (Public Health Agency of Canada 2026).

6. Yellow Flags: Factors that May Affect Recovery or Participation

Yellow Flags are personal, social, work, school, healthcare, environmental or structural factors that may influence symptoms, functioning, participation or response to care. They are contextual, not diagnoses or certain predictions, and do not mean that symptoms are psychological. They guide how care is tailored and do not by themselves require urgent referral. Explore them through conversation and ongoing outcome review, with attention to the patient’s priorities, strengths and circumstances. A separate Yellow Flag score is not required. New or worsening signs of serious physical illness follow the Red Flag process. Mental health or substance use concerns that need separate assessment, or any immediate safety concern, follow the Orange Flag process and applicable emergency or safeguarding procedures.

Explore relevant factors:

  • Understanding, expectations and healthcare experiences: concerns about injury or damage, uncertainty, recovery expectations, confidence, conflicting advice, previous dismissal or harm, and trust in care.
  • Responses to symptoms and activity: worry, fear, avoidance, cycles of doing too much and then needing prolonged rest, difficulty pacing, coping, sleep, confidence in self-management, and return to meaningful activities.
  • Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
  • Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
  • Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
  • Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

  • Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
  • Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
  • Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
  • Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
  • Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.
7. Examen physique

Select examination elements that answer a clinical question or may change care. Adapt the examination to the patient’s presentation, comfort, consent and abilities.

  • Consent and comfort: explain what you propose, provide choices about positioning, draping, pace and support, and confirm ongoing consent, especially before provocative or hands-on testing.
  • Condition-specific safety: begin with the history and observations needed to decide whether examination is appropriate. Defer or modify testing when suspected fracture, infection, acute neurological compromise, severe irritability or another safety concern makes it inappropriate.
  • Observation and relevant vital signs: general appearance, distress, posture, transfers, gait, antalgia, balance, use of supports and footwear; blood pressure, pulse, temperature or other observations when the presentation indicates.
  • Movement and range of motion: active and passive hip flexion, extension, abduction, adduction and internal and external rotation as relevant; note range, quality, pain, stiffness, end-feel and comparison with the other side. Internal rotation and flexion are often limited early in hip OA. (Koc et al. 2025).
  • Strength and motor performance: assess hip and lower-limb muscle performance relevant to the patient’s presentation, including abductors, extensors, flexors and rotators, and relate findings to gait and functional tasks. (Koc et al. 2025).
  • Palpation : bones, joint region and soft tissues when tenderness, swelling, temperature change or symptom reproduction may inform the differential or care plan; palpation does not establish hip OA on its own.
  • Neurological and regional examination when indicated: lower-limb strength, sensation, reflexes and neural provocation; lumbar spine, pelvis, knee, vascular, abdominal or other regional assessment when the history suggests an alternative or overlapping source.
  • Hip provocation tests: use selected tests to reproduce the familiar symptoms and examine joint irritability or alternative intra-articular and extra-articular presentations. Interpret tests with the history, range of motion and functional findings rather than as stand-alone diagnoses. (Koc et al. 2025).
  • Functional and performance assessment: select tasks tied to the patient’s goals, such as walking, sit-to-stand, stairs, single-leg balance, dressing, getting in or out of a vehicle, work tasks or caregiving. Timed walking, chair-stand, stair or balance measures can be used when they will guide care. (Koc et al. 2025).
  • Imagerie : not routine for a typical clinical presentation. Use it when atypical features or another diagnosis are suspected, after relevant trauma, or when the result is likely to change care, referral or surgical planning. Radiographs are the usual first imaging study when imaging is required. (NICE 2022; ACR Chronic Hip Pain 2022 Update).
  • Reassessment: repeat the findings and functional tasks needed to review progress, revisit the working clinical presentation, identify adverse effects or decide whether further assessment or referral is appropriate.
8. Présentations cliniques

Use these as working clinical descriptions rather than fixed stages or definitive explanations of pain. Presentations can overlap or change, and imaging findings do not determine symptoms or care on their own (NICE 2022; Koc et al. 2025).

  • Typical clinical hip OA presentation: in an adult aged 45 or older, activity-related hip or groin pain with no morning joint stiffness or stiffness lasting no longer than about 30 minutes, together with painful or restricted hip movement. Reduced internal rotation and flexion support the clinical impression but are not diagnostic alone. (NICE 2022; Koc et al. 2025).
  • Hip-dominant mobility, strength or gait presentation: hip pain and stiffness are accompanied by restrictions in range, lower-limb muscle performance, walking, stairs, transfers, balance or other tasks that matter to the patient.
  • Bilateral or multisite OA presentation: both hips or other joints contribute to symptoms, activity limitations, sleep, work or participation. Assessment and care reflect the combined effect rather than treating each joint in isolation.
  • Flare, persistent or high-impact presentation: symptoms temporarily worsen or remain substantially limiting. Revisit safety, the differential diagnosis, treatment burden, access, comorbidities and the patient’s interest in medical or surgical assessment.
  • Alternative or overlapping presentation: findings may point to lumbar referred or radicular symptoms, greater trochanteric pain, a non-arthritic intra-articular hip disorder, osteonecrosis, inflammatory disease, fracture, infection, pelvic or abdominal disease, vascular disease or another source. Document uncertainty and the referral or shared-care plan.
9. Considérations relatives au traitement

Base care on the presentation, safety, goals, context and response. Use adaptable options rather than a ranked sequence, and repeat meaningful outcomes to guide change (NICE 2022; Moseng et al. 2024).

Education, self-management and participation

  • Options include clear explanations that challenge unhelpful beliefs; information about the variable course and flares; activity, pacing, sleep, work and symptom-management strategies; and support for continued participation in valued roles (NICE 2022; Moseng et al. 2024; Koc et al. 2025).

Physical activity and exercise

  • Options include individualized strengthening, mobility, aerobic, aquatic, endurance, functional, gait and balance exercise, along with general physical activity. Type, dose, setting and progression reflect goals, capacity, access, other health conditions and response (Koc et al. 2025; Moseng et al. 2024; NICE 2022).
  • Walking sticks, crutches, walkers and other assistive devices can form part of care when they improve safety, balance, walking or independence; fit and use are reviewed with the patient (Koc et al. 2025; Moseng et al. 2024; NICE 2022).

Weight and broader health support

  • When weight management is relevant and acceptable to the patient, options include non-stigmatizing support for individualized nutrition, physical activity and behaviour goals, with access to a dietitian, physician or community service when useful. Weight is not treated as a prerequisite for other appropriate care or referral (NICE 2022; Moseng et al. 2024; Koc et al. 2025).

Hands-on and symptom-relieving care

  • Options include hip joint mobilization, selected manipulation and soft-tissue techniques for people with mild-to-moderate hip OA and relevant pain, mobility or flexibility impairments. These approaches can be used alongside exercise, with the purpose and response reviewed over time (Koc et al. 2025; NICE 2022).
  • Traditional, Indigenous, cultural or community-based approaches identified by the patient can form part of care when they are safe, acceptable and coordinated as needed.

Psychological, social and interdisciplinary support

  • Options include pain-coping and behaviour-change strategies, support for distress or sleep concerns, workplace or caregiving adaptations, and connection with relevant clinical, community, Indigenous or culturally specific services (Moseng et al. 2024; NICE 2022).
  • Medical or orthopaedic assessment can be arranged when symptoms and functional limitations substantially affect quality of life and acceptable non-surgical options are ineffective or unsuitable, or when the patient wants to discuss joint replacement (NICE 2022).

Medication and medical options

  • Medication decisions sit with an authorized prescriber or pharmacist. Options may include an oral non-steroidal anti-inflammatory drug when clinically appropriate; risk review includes gastrointestinal, renal, liver and cardiovascular factors, other medicines, pregnancy and comorbidities, with the lowest effective dose used for the shortest practical time (NICE 2022; AAOS 2023).
  • An image-guided intra-articular corticosteroid injection may be discussed with an authorized medical provider for short-term symptom relief or to support participation in exercise when other options are ineffective or unsuitable. The discussion includes infection and rapidly progressive OA risk as well as expected duration of benefit (NICE 2022; AAOS 2023).

Monitoring and reassessment

  • Agree on a reassessment point based on presentation, safety, goals, care being tried, patient needs and access rather than a fixed visit schedule.
  • Repeat the baseline outcome set and review symptoms, relevant examination findings, functioning, participation, benefits, harms, treatment burden and progress toward patient-defined goals.
  • Continue what is useful and acceptable; adapt or stop what is not; and revisit the clinical presentation, differential diagnosis, imaging, referral or shared care when progress differs from expectations or new safety concerns emerge.
10. Prognosis and Prognostic Factors
  • Expected course: prognosis is individual. Hip OA is a long-term condition with a variable course. Pain, stiffness and activity limitations may improve, remain stable, worsen or fluctuate, and symptom severity does not always correspond to imaging findings. Individual outcomes cannot be predicted with certainty. (NICE 2022; Koc et al. 2025).
  • Factors associated with a less favourable course: greater symptom burden, reduced physical functioning, multiple health conditions and activity avoidance may be associated with poorer functioning over time. (Cijs et al. 2025; NICE 2022).
  • Potential supports for recovery: feasible exercise and self-management options; confidence and active coping; supportive relationships, workplaces and communities; appropriate assistive devices; care for relevant health conditions; and progress toward meaningful activities may support functioning. (Moseng et al. 2024; NICE 2022; Koc et al. 2025).
  • Discussing prognosis: describe the course as variable and uncertain, avoid deterministic language, and ask what the patient wants to know. Use repeated outcomes and the observed response to care to update the plan. Revisit the working clinical presentation, safety and referral needs when the course differs materially from expectations. (NICE 2022; Koc et al. 2025).
11. Suivi continu

Ongoing follow-up is a shared review of whether the plan remains safe, useful, acceptable and aligned with the patient’s goals. The timing of review should reflect symptoms, risk, the care being tried, goals and access rather than a fixed visit schedule.

  • Review symptoms and safety: ask what has changed in symptoms, functioning and daily activities; review adverse effects; and check for new or worsening Red Flags and relevant Orange or Yellow Flag concerns. Arrange earlier or urgent assessment when the findings require it.
  • Review outcomes: repeat the small set chosen at baseline and use the same measures when possible. These may include the Patient-Specific Functional Scale, WHODAS 2.0, quality of life using the patient’s own rating or a measure such as WHOQOL-BREF, symptom impact, participation and the patient’s own assessment of change. Interpret measures with the patient and alongside what has changed in daily life rather than relying on a score alone.
  • Review goals, preferences and consent: ask whether care remains acceptable, feasible and worthwhile; revisit goals and priorities; and confirm consent when the plan or circumstances change.
  • Adapt care: continue what is useful and acceptable, and change, pause or stop what is not. If progress is not sufficient from the patient’s perspective, review the clinical impression, the fit and amount of care, barriers to participation, other health or social factors and whether other expertise is needed.
  • Support self-management and participation: review the strategies the patient is using, including physical activity or exercise, symptom management, pacing and participation in work, school, caregiving, recreation or community life. Ask what is helping and which barriers can be addressed.
  • Orientation et cogestion : arrange emergency assessment for Red Flags requiring urgent care. Consider referral or co-management when findings or needs are beyond the clinician’s role, the patient’s condition is worsening, progress remains insufficient after the plan has been reviewed, or the patient requests another opinion.
  • Plan the next step: agree whether to continue, change the interval between visits, move toward more self-directed care, or apply the Criteria for Discharge section.
12. Critères de sortie

Discharge is a shared decision about ending or transferring a course of care. It does not require complete symptom resolution, a normal outcome score or a fixed number of visits.

  • When discharge may be appropriate: consider discharge when the patient’s goals have been met to a degree they consider satisfactory; the patient feels able to manage with less or no clinician involvement; the patient chooses to end care; continued care is not providing enough benefit to justify its burden, cost or time; or care is being transferred to another provider.
  • Reassess before discharge: review symptoms, functioning, participation, selected outcomes, goals, adverse effects, confidence and preferences. Check for new or worsening Red Flags and any Orange or Yellow Flag concerns that still require action. If the condition is worsening or a safety concern remains, arrange the required assessment or referral rather than routine discharge.
  • When progress has slowed: review the clinical impression, response to care, goals, barriers and access, other health or social factors, and other reasonable options before deciding with the patient whether to continue, change or end care.
  • Plan after discharge: agree on self-management, physical activity or exercise, symptom management, pacing and participation in work, school, caregiving, recreation or community life. Explain which changes should prompt earlier or urgent assessment and when and where to seek care.
  • Future access to care: explain how the patient can return if symptoms recur, functioning declines, or goals or demands change. Any planned future review or supportive care should have an agreed purpose, expected benefit and review point.
  • Referral or transfer: explain the reason, share a relevant summary with the patient’s consent, and clarify who will address outstanding concerns when possible. Avoid an unintended gap in care when safety or ongoing needs remain.
  • If the patient ends care or does not return: respect the patient’s right to stop. Record what is known and unknown about the outcome, advice or referral offered, attempts to communicate when clinically warranted, and any unresolved safety concern. Follow applicable record keeping and communication requirements.
  • Documentation : record the reason care ended, the patient’s status and selected outcomes, goals and preferences, unresolved concerns, advice and self-management plan, referral or transfer details, and how to seek care again if needed.

Références

Disclosure: Generative artificial intelligence tools assisted with drafting, editing, reference organization and hyperlink checking. They did not approve the pathway or replace clinical judgment. The clinical content, evidence selection, citations, links and final wording have been verified by CCG reviewers.