RAG rating

n/a

Document type

Clinical pathways

Place

Hertfordshire and West Essex ICB

Output type

Clinical Pathways

Pathway

Hip Pain | Adults V7 1April 2026Hip Pain Due To Osteoarthritis

Information leaflet

MSK Triage Leaflet

Hip Pain

 Pathway Publish Date: April 2026

Pathway Next Review Date: April 2028

 

PLEASE NOTE FOR MOST MSK PATHWAYS –

• DO NOT ORDER MSK MRIs FROM PRIMARY CARE.
• UNLESS THE PATIENT HAS A RED FLAG MOST MSK PATHWAYS REQUIRE A PERIOD OF CONSERVATIVE MANAGEMENT AND REFERRAL ONLY ON NON-RESOLUTION ONTO TO PHYSIO OR MSK TRIAGE SERVICES (SEE DETAIL FOR EACH PATHWAY ATTACHED).
• PLEASE NOTE MSK TRIAGE SERVICES CAN ORDER MRIs AND OTHER DIAGNOSTICS ONLY REFER DIRECT TO SECONDARY CARE IF RED FLAGS.

  
  
  Osteoarthritis of the hip is more likely if:

• Patient > 45 years old; and
• Has activity-related joint pain; and
• Has either no morning joint-related stiffness; or morning stiffness that lasts no longer than 30 minutes.

Confirmation of Osteoarthritis and Severity

Plain x-ray

Conduct baseline Oxford Score. http://www.orthopaedicscore.com/scorepages/oxford_hip_score.html

Record height, weight and BMI

Initial non-surgical management

• Weight reduction (if BMI > 25)
• Adequate doses of NSAIDs and analgesics
• Modifying activity
• Introduce walking aids
• Physiotherapy and/or other therapies

  Continue Conservative Management For 6 months if: Oxford score ≥ 20; or BMI > 30 and has not lost 10% body weight in last 6 months

  Indications for referral

• No improvement despite conservative management; and:
• Oxford score is less than 20
• X-ray confirms moderate or severe osteoarthritis
• BMI is less than 30 or has lost at least 10% body weight within the last 6-9 months (documented)
• patient has been advised to stop smoking
• Oxford score of 30 or more should be managed in primary care and not referred unless exceptional circumstances
• Oxford score of 20-29 should be managed with 6 months of conservative treatment in the first instance

  Red Flags

  Refer the patient as an emergency to secondary care if:

• Suspected hip fracture
• Associated systemic features
• Signs of infection
• Known primary malignancy
• Severe muscle spasm
• Sudden inability to bear any weight
• History of a fall

  
  
  What to include in referral: 

• Confirm osteoarthritis and severity with plain x-ray
• Conduct baseline Oxford Score. http://www.orthopaedicscore.com/scorepages/oxford_hip_score.html
• Record height, weight and BMI
• Evidence of 10% weight loss over last 6-9mths if BMI>30

  For other causes of hip pain:

• If suspected inflammatory arthritis, refer to rheumatology
• For soft tissue conditions, advise initial self-management for 6 weeks.  If there is no improvement, refer to physiotherapy
• For Paget’s disease of the hip, advise initial self-management for 6 weeks.  If there is no improvement, refer to physiotherapy