GP triage – Hip Menu
Common Hip Problems
OA Hip

Affected Area
- Groin/ Buttock pain
- Commonly refers to anterior thigh and knee
- Pain on walking, stairs, prolonged weight bearing.
- Stiffness of <30 mins after prolonged inactivity
- Decreased ROM, crepitus and pain on movement
- Unable to touch feet/ functional difficulty with shoes and socks
- Education & advice
- Exercise
- Simple analgesics
- NSAIDS
- Walking aid as required
- Weight loss
- Physio referral
- X-ray: AP Pelvis
- Symptoms persist more than 3/12 despite analgesics
- Considering joint injection
- Consider referral for joint replacement surgery if patient restricted and willing
- Patient specific factors such as age, gender, smoking, obesity and co-morbidity should not be barriers to referral
Lateral Hip Pain

Affected Area
- Pain over Greater Trochanter
- Worse on walking/ Standing
- Pain with hip abduction
- Pain on palpation
- Pain in side lying
- Education & advice
- Exercise
- Simple analgesics
- NSAIDS
- Physio referral for patients > 6/52
- Consider a single steroid injection
- No imaging necessary unless fracture suspected.
- Refer to MSK service- No response to conservative treatment.
- Refer to physiotherapy- Struggling with ADLs/ work/ conservative treatments.
Anterior Hip Pain

Affected Area
- Deep anterior Hip and Groin pain.
- Acute related to Injury or insidious related to overuse
- Agg’s: prolonged sitting/ walking/ crossed legs/ during sports and exercise (Flexion/ Medial rotation)
- Pain intermittent and mechanical
- Decreased hip flexion and Internal rotation
- Under 45 years old
- Education & advice
- Exercise
- Simple analgesics
- NSAIDS
- Physio referral
- No imaging necessary in initial stages
- X-ray: AP Pelvis
- Onward referral to MSK service if CAM or Pincer deformity with signs of impingement.
- Hip pain with associated systemic symptoms, signs of infection, known primary malignancy.
- Severe Muscle spasm, inability to bear any weight, history of a fall.
- No response to conservative treatment – refer to MSK service
Posterior Hip Pain

Affected Area
- Pain in Buttock
- May be referred from lumbar spine or pelvic joints
- Consider Spinal source
- Education & advice
- Exercise
- Simple analgesics
- NSAIDS
- Physio referral
- X-ray: AP Pelvis
Consider inflammatory disorders (sacrolitis). If suspected arrange blood screen (ESR, CRP)
- No response to conservative treatment – refer to MSK service
- Consider referring to Rheumatology if tased inflammatory markers/ HLA b27 +ve
- Orthopaedics if severe OA shown on X-ray
Post THR Pain

Affected Area
- THR within previous 6 months
- Rule out red flags: Infection, night pain, fever, sweats, increased pain
- Education & Advice
- Physio referral
- Consider x-ray AP Pelvis and Hip
- Bloods if suspicious of infection
- Clinical consideration of Sepsis if < 3/12 post-op
- Refer to MSK service – No response to conservative treatment.
- Refer to Orthopaedics – if Anterior pain and no red flags.
- Refer to Orthopaedics – if signs of loosening/ infection.
Avascular Necrosis

Affected Area
- Pain with weight bearing
- Patient may have had previous hip fracture, HIV/ Alcohol, steroid usage or sickle cell anaemia
- May have absence of stiffness
- Analgesics
- Walking aid provision
- X-ray: AP Pelvis
- URGENT referral to orthopaedics: Hip pain associated with systemic symptoms, signs of infection, known primary malignancy, severe muscle spasm, sudden inability to bear any weight, history of fall.
- If patient has sickle cell anaemia – refer to Haematology.