- Document type
- Clinical pathways
- Place
- Hertfordshire and West Essex ICB
- Output type
- Clinical Pathways
- Pathway
- Hip Pain | AdultsHip Pain Due To Osteoarthritis
- Information leaflet
- MSK Triage Leaflet
Hip Pain
Pathway Publish Date: March 2024
Pathway Next Review Date: March 2026
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