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: 

  • 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
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