Which scenario is an indication for total hip arthroplasty in osteoarthritis?

• A. Intractable pain and functional limitation not relieved by conservative care, with radiographic evidence of advanced OA.
• B. Radiographic evidence of OA with no symptoms.
• C. Pain controlled with NSAIDs and physical therapy.
• D. Intractable pain but radiographic OA is not advanced.

Answer: (D)

The key idea is that total hip arthroplasty is driven by the patient’s symptoms and functional impairment, not strictly by how advanced the radiographs look. If pain is severe and disabling and conservative treatments have failed, surgery can be indicated even when imaging isn’t showing advanced OA. The goal of the operation is to relieve pain and restore function, which is why this scenario—intractable pain with functional limitation despite nonoperative care, even without advanced radiographic changes—fits the indication.

The other scenarios are less supportive because they either lack persistent symptoms (pain with NSAIDs/therapy managed) or rely on imaging alone without disabling symptoms (radiographic OA with no symptoms).