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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.
In the young adult, Femoro-acetabular impingement (FAI), labral tears and hip dysplasia may cause hip pain, usually felt in the groin.
Trochanteric pain with local tenderness is often due to trochanteric bursitis or abductor tendinopathy. Isolated trochanteric pain due to bursitis or tendinopathy settles in 64% after one year and 71% after five years. Please do not request US guided injections of trochanteric bursitis.
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 (see link to Osteoarthritic Hip Pain CRG).
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 caused by confirmed osteoarthritis: (see link to Osteoarthritic Hip Pain CRG).
Please include detail such as:
NB: Isolated pain over the greater trochanter due to bursitis or tendonopathy settles in 64% of patients after one year and 71% after five years.
Examine the hip for tenderness and irritability on movement.
The clinical indications for this are:
In addition, an up-to-date X-ray is extremely beneficial 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.
MRI requests can be made by the Extended Scope Physiotherapist (ESP) or Integrated Clinical Assessment and Treatment (ICAT) clinician; GPs are no longer able to order MRI through the Any Qualified Provider (AQP) process.
DRSS will review the referral letter and direct to Orthopaedics if
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 the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.
MyHealth Devon - Hip Pain (Osteoarthritis)
MyHealth Devon - Hip Impingement (Femoroacetabular impingement))
This guideline has been signed off on behalf of the NHS Devon.
Publication date: July 2020
Updated: December 2023