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GP triage – Hip Menu

Common Hip Problems

OA Hip
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
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
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
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
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
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.