Diagnosis and treatment of Hip Pain in Adults

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Red flags and urgent referrals Urgent referral to Orthopaedics by telephone to hip specialist for the following symptoms: • Unable to walk • Trauma • Unable to move hip • Septic/unwell • Systemic symptoms • Signs of infection • Known primary malignancy • Raised inflammatory markers • Severe muscle spasm • Sudden deterioration of chronic hip pain GP diagnostic triage • FBC, LFT, CRP, plasma viscosity, bone profile, RFT, PSA • Recommended primary care medical management should include: Analgesia (see local Joint Formulary for details) Advice to use a walking stick in opposite hand from affected side joint Advise to reduce weight if obese Consider x-ray if diagnosis uncertain or if confirmation required (AP pelvis) Consider referral to Phyiotherapy if functionally impaired Specific Diagnoses: Inflammatory Primary care action • Analgesia (See local Joint Formulary for details) • NSAIDs plus PPI • See NICE guidance for further advice Consider orthopaedic referral for Avascular Necrosis (AVN) Referral to Rheumatologist or Orthopaedic surgeon Mechanical a) Soft tissue (eg trochanteric bursitis) • Pain and tenderness on palpation directly over the superoposterior aspect of the greater trochanter Weakness/pain on resisted abduction Consider injection and referral to phyiostherapist Referral to Orthopaedic surgeon b) Osteoarthritis • Patient presents with groin or buttock pain which is worse on weight-bearing Range of movement is affected, in particular medial/internal rotation, flexion and abduction and activities of daily living Referral to physiotherapist or Occupational therapist for appropriate aids Referral to Orthopaedic surgeon c) Young adult hips Young adult hip problems include: • Patient less than 50 years of age and older than 18 years • Old Perthes • Slipped upper femoral epiphysis • Congenital dislocation of hip • OA and avascular necrosis • Labral tear • Snapping ilio-tibial band • Femoroacetabular impingement (FAI) Diagnostic tests: X-ray where indicated - standing AP pelvis cross table laterals Referral to Musculoskeletal service Painful THR X-ray where indicated standing AP pelvis and cross table lateral Referral to Orthopaedic Surgeon