Reviewed on : 9 Oct 2023

Reviewed by : Richard Westerman Consultant Orthopaedic Surgeon UHCW & Gateway Editor & Cheryl Johnson Project Leader UHCW

Expires : 9 Oct 2025

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

Moderate/ Severe Hip Arthritis

Previous Hip Replacement with pain or reduced function

 

 

Previous Hip Replacement with pain or reduced function

Previous Hip Replacement	With pain or reduced function
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	X-Ray within 6 months: AP Hips + Lateral Hip
Management plan	Referral to Revision Hip Surgeon if specific hip joint concerns Referral to Physiotherapy and encourage Weight Loss if specific trochanteric pain

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

Hip Resurfacing Policy

Prior approval from the Integrated Care Board (ICB) will be required before any treatment proceeds in secondary care unless an alternative contract arrangement has been agreed with the ICB that does not necessitate the requirement of prior approval before treatment

Background

MoM hip resurfacing arthroplasty involves removal of the diseased or damaged surfaces of the head of the femur and the acetabulum

The femoral head is fitted with a metal surface and the acetabulum is lined with a metal cup to form a pair of metal bearings

There is sufficient short-term evidence to conclude that hip resurfacing is clinically and cost-effective but the studies have been undertaken in people aged under 65 years.

NICE guidance recommends their use in those likely to outlive a conventional THR (i.e. young and active), but advises surgeons to discuss the lack of long-term evidence on safety and reliability with patients

As per NICE guidance Prostheses for total hip replacement and resurfacing arthroplasty are recommended as treatment options for people with end-stage arthritis of the hip only if the prostheses have rates (or projected rates) of revision of 5% or less at 10 years. Prosthesis with less than 10 years of data can only be used provided that the revision rate was consistent with 5% or less at 10 years (as much as the shorter term follow up data allow)

Indication

Osteoarthritis

The ICB will only fund Metal on Metal (MoM) hip resurfacing arthroplasty when the procedure and follow-up process meets current NICE and Medicines and Healthcare Products Regulatory Agency (MHRA) guidance and the patient meets the following criteria:

• The patient qualifies for primary total hip replacement; AND
• The patient is likely to outlive conventional primary hip replacements

References

NICE Technical Appraisal Guidance (TA 304) Total hip replacement and resurfacing arthroplasty for end-stage arthritis of the hip, 26th February 2014

https://www.nice.org.uk/guidance/ta304