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This is the commissioned pathway for hip pain due to osteoarthritis
450 patients per 100 000 population present to primary care annually with hip pain
25% resolve in 3 months – 35% at 12 months
Pain felt around and attributed to the hip can also be due to spinal or abdominal disorders which should be excluded.
Hip pathology may cause pain felt only at the knee.
Degenerative hip disease is the most common diagnosis in the adult and is the long-term consequence of predisposing conditions.
Osteoarthritis (OA) may not be progressive and most patients will not need surgery, with their symptoms adequately controlled by nonsurgical measures. Symptoms progress in 15% of patients within 3 years and 28% within 6 years.
Unless red flags are present all patients referred for consideration of arthroplasty due to osteoarthritis will be assessed by a community assesment service which provide a holistic assessment of their symptoms and disabilities before being helped to make a decision on the possible treatment options. This assessment will include Oxford hip scoring and patient decision making aids. Treatment options will include lifestyle modifications, physiotherapy, improved general health and well being or surgery.
Please note pre-referral criteria are applicable in this referral and referrals may be returned if this information is not contained within the referral
Please note primary care is encouraged to follow In Shape for Surgery best practice which can be seen here.
Hip pain for reasons other than osteoarthritis: see Hip Pain and Management in Adults
Please include detail such as:
Red Flags which will bypass the Community Assesment Service (should be referred urgently to secondary care)
The clinical indications for this are:
1) to rule OA in or out as a differential for the patient's symptoms
2) to ensure that deterioration in symptoms isn't due to potential Red Flag conditions e.g., avascular necrosis (an indication for expedited referral)
3) deterioration in OA can result in more complex and time-consuming operations. If this is known, then the appropriate surgical list time can be allocated, hence avoiding cancellations of procedures later in the list
In addition, an up-to-date X-ray is extremely useful for remote/virtual consultations.
Please consider repeating an X-ray if a significant time has elapsed since the last one, or there has been a significant change/progression in your patient’s symptoms. This will aid in remote/virtual consultations and help to avoid delay in diagnosis of differentials/red flag conditions.
Unless red flags are present all patients referred for consideration of arthroplasty due to osteoarthritis will be assessed by a community assessment service which provide a holistic assessment of their symptoms and disabilities before being helped to make a decision on the possible treatment options. This assessment will include Oxford hip scoring and patient decision making aids. Treatment options will include lifestyle modifications, physiotherapy, improved general health and well being or surgery.
Referral to specialist secondary care:
All referrals should include:
All referrals must include:
The clinical indications for this are:
In addition, an up to date X-ray is essential to facilitate remote/virtual consultations
Please consider repeating an X-ray if a significant time has elapsed since the last one, or there has been a significant change/progression in your patient's symptoms. This will aid in remote/virtual consultations and help to avoid delay in diagnosis of differentials/red flag conditions.
Please ensure that the X-ray report is attached to avoid unnecessary delay.
It is the responsibility of the referrer to attach the report.
Please note primary care is encouraged to follow In Shape for Surgery best practice which can be seen here.
Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of NHS Devon upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.
MyHealth patient information - Hip pain
This guideline has been signed off on behalf of the NHS Devon.
Publication date: July 2020
Updated: December 2023