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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.