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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.


COVID-19 Adjusted Treatment Pathways

Community Physiotherapy are now injecting all patients, both high and low risk with the only caveat is that we will leave 2 weeks prior or after vaccination to inject (June 2021)

Steroid joint injections are not currently being performed at UHCW in Musculo-Skeletal / Orthopaedics / Radiology. Please do not currently refer to UHCW for this purpose.

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

Please note that Primary Hip Replacement is considered a Low Priority Procedure (LPP) when referral is considered. Please see section on Primary Hip Replacement below

These guidelines are divided into three categories:

Non Arthritic Hip

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

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 with pain or reduced function

 

Previous Hip Replacement                          

With pain or reduced functionpage4image7657280

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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Referral for Primary Hip Replacement (Low Priority Procedure LPP)

Referral Criteria (Please use referral form – link on right): 

1. Patients shall be eligible for surgery if the following criteria is met in either Section a, b or c:

Section A

Patients shall be eligible for surgery if ALL of the following criteria are met:

  • The patient has been referred to and managed by a musculoskeletal (MSK) service AND
  • The patient has a BMI below 35 AND
  • Please confirm that the patient is supported by a primary care and/or community service referral AND
  • Please confirm that conservative means (e.g. Analgesics, NSAIDS, physiotherapy, advice on walking aids, home adaptations, curtailment of inappropriate activities and general counselling as regards to the potential benefits of joint replacement) have been exhausted and failed to alleviate the patient’s pain and disability AND
  • Please confirm that the patient’s pain and disability is sufficiently significant to interfere with the patients’ daily life and or ability to sleep AND
  • Please confirm that the patient accepts and wants surgery

All boxes in section A need to be ticked to meet the criteria for referral

Section B

  1. 1) Patient has a BMI of 35 or over but mobility is so compromised that they are in immediate danger of losing their independence and that joint replacement would relieve this threat  

2) Loss of Independence Unable to maintain activities of daily living 4 out of 6 need to require assistance:

  • Dressing
  • Walking
  • Transferring from a chair
  • Bathing
  • Climbing Stairs
  • Driving

One box in section B needs to be ticked to meet the criteria for referral

Section C

Patient has a BMI of 35 or over but the destruction of their joint is of such severity that delaying surgical correction would increase technical difficulty of the procedure (Recent x-ray report required)  

If the patient does NOT meet any of the above criteria

  • If the patient does not meet any of the above criteria and has a BMI of 35 or over they will be referred by their GP to weight management services and will be expected to engage with the services to achieve the required BMI.
  • Should the patient’s BMI fall below 35 then the patient would be eligible for surgery in line with the policy criteria.
  • If this weight loss cannot be achieved the patient will be eligible for referral for surgery from two years after the documented date of the GP referral to weight management services for the purpose of weight loss prior to surgery.

Please attach any relevant tests, investigations or clinic letters.

One box in section C needs to be ticked to meet the criteria for referral

Post Operative Joint Replacement Management

See link right for full leaflet

Summary: 

Antibiotics may mask the joint infection temporarily but they are unlikely to cure it.

They will also compromise the success of any further treatments.

Therefore, if you have any queries or concerns please leave a voice mail message on the number below for advice.

We will organise the necessary investigations and arrange an appointment if required.

Contact: 024 7696 8333

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