I am 62-yerar old male, good health, 6’3” 260 lbs. In 1994 had left femur neck fracture due to car accident, OS saved the femur neck with 3 pin fixation. Lately hip has become painful, walking and exercise increases pain, stopped all exercise except walking our dog daily. Also, developed a limp trying to limit the rotation of the hip joint. OS xray reading notes say: no necrosis, severe osteoarthritis of left hip, bone on bone, subchondral sclerosis and cystic, prominent juxta-articular osteophytes. Recommendation is to schedule a THR. I have been reading BoneSmart and learned a lot from all of you. I have a question for you: what are best practices for OS to diagnose OA and recommend a THR? Is a OA diagnosis and THR recommended based on x-ray reading and patient’s description of pain? Are there any other medical evaluation or criteria used to determine if THR is the only or best course of action? Reason I ask is that although my xray notes say bone on bone, I don’t have the typical pain in the groin associated with OA of the hip. My hip pain is around my greater trochanter. I can have pain when resting, depending on position, but have sharp pain with extended walking or just standing, pain can shoot down the femur to the knee. But vigorous massage of the GT area reduces this pain temporary. I wonder if my pain is due to bursitis. Could my condition be misdiagnosed? Therefore my question: Do OS rely only on x-rays to identify OA and recommend THR? What are best practices to diagnose OA and recommend a THR?