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Hip Pain (Adults)

  

Most cases of hip pain in adults that are treated with surgery are caused by osteoarthritis, the most common type of arthritis in the UK.


Referral to Adult Physiotherapy Service

If patients have ongoing musculoskeletal hip pain and have not improved with relative rest or analgesic advice consider referral to the Adult Physiotherapy Service for assessment & treatment with:

  • Advice
  • Specific exercises
  • Mobilisations/ soft tissue techniques
  • Acupuncture
  • Injection – for lateral hip/ GTPS only – No hip joint injections provided
  • Appropriate walking aids
  • Investigations or secondary care referral if appropriate
Hip Pain Referral Guidelines

These guidelines are divided into three categories:

Non Arthritic Hip

Moderate/ Severe Hip Arthritis

Previous Hip Replacement with pain or reduced function

Non Arthritic Hip                      

Clinical Examination

 

  • Asymmetrical range of movement
  • Pain on rotation and flexion
  • Hip joint pain: described as deep or groin
  • Lateral soft tissue tenderness: identified to direct palpation

Radiology

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  • X-Ray within 6 months: AP Hips
    If normal consider MRI Hip

Management

  • Trial of Physiotherapy and analgesia
  • Then consider referral to Hip Preservation Surgeon if non-arthritic hip pain

Moderate/ Severe Hip Arthritis                                         

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Clinical Examination

  • Loss of the range of movement
  • Pain on rotation and flexion
  • Pain described as deep or groin
  • Pain can radiate down anterior thigh
  • Pain sometimes only causes ‘knee’ pain
  • Not pain to direct palpation laterally over trochanter

Radiology

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  • X-Ray within 6 months: AP Hips (request templating marker to be applied, if possible)
  • Note: MRI scan is not helpful for assessing arthritis

Management

  • Consider trial of Physiotherapy and analgesia (if appropriate)
  • Referral to Hip Surgeon if fit enough and willing to consider surgery and consistent with Low Priority Procedure Guidelines (see right)

 

Previous Hip Replacement                          

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Clinical Examination

  • Concern if pain on standing from a sitting position or on weight bearing
  • Note: Hip joints should not be painful after a joint replacement, however trochanteric pain is common

Radiology

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  • X-Ray within 6 months: AP Hips + Lateral Hip

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Management plan

  • Referral to Revision Hip Surgeon if specific hip joint concerns
  • Referral to Physiotherapy and encourage Weight Loss if specific trochanteric pain

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