Young Adult Hip Pain
Red Flags
- Send to Emergency Department or discuss with Orthopaedic Registrar on call
- Severe hip pain and sudden inability to weight bear +/- history of fall
RCHT, not community hospital/minor injury clinics
- Sudden severe significant deterioration of chronic hip pain
- Sudden change in true leg length
- Suspected sepsis of hip joint
- Systemically unwell with NEW severe hip pain
If concern regarding suspected new malignancy please refer via 2 Week Wait Criteria.
- X ray suggests the possibility of Sarcoma
- Myeloma work up http://rms.kernowccg.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/haematology/mgusmyeloma
- Common metastases to bone: Prostate, breast, renal, lung, thyroid
- Please include information on their previous treatment and prognosis
- 2WW/Oncology if known primary/unknown origin
Urgent Referral To Fracture Clinic
X-ray confirmed avascular necrosis with femoral head collapse
Rheumatology
Most cases of inflammatory hip arthritis are Seronegative Spondyloarthropathies. Rheumatoid arthritis of the hip is rare.
Consider inflammatory screen (FBC, U&E, CRP, ESR, Bone profile, Urate) if there are symptoms suggestive if inflammatory arthritis such as significant stiffness, quick symptom progression, risk factors and/or significant pain with a good amount of joint space on X ray
After excluding red flags consider
· Femoral acetabular impingement
· Hip dysplasia
· Osteoarthritis If abnormal X-ray film suggestive of OA follow Chronic Hip Pain guidelines
· Trochanteric bursitis
· Tendinopathies affecting the adductors, psoas and hamstrings
· Referred pain
Information Required Before Referral
Inflammatory screen (FBC, UE, CRP, ESR, Bone profile, Urate) if there is suspicion of an inflammatory cause, risk factors or significant pain with a good amount of joint space on Xray
Femoral Acetabular Impingement
Conservative Measures
- Analgesia
- Reduce pain provocating/inducing activities
- Three months of supervised physiotherapy
Referral Criteria For Femoro-acetabular impingement:
- Persistent pain which affects sleep, activities of daily living, work or leisure where conservative measures have failed – including activity modification, pharmacological intervention and physiotherapy1 AND
- Patients between 16-50 years AND
- Patient wishes to undergo surgery
X-Ray is required within 6 months of referral
MRI arthrograms are not indicated in Primary Care, requested by hip surgeon only
Significant Functional Impairment is defined as:
· Symptoms that result in an inability to sustain employment despite reasonable occupational adjustment, or act as a barrier to employment, education or maintaining sport activities
· Symptoms preventing the patient carrying out self-care, maintaining independent living or carrying out carer activities
Evidence of functional impairment must be supplied with the referral documentation
Please consider fitness for surgery and optimise medical management if needed
Contributors
Dr. Rebecca Hopkins GP and Kernow RMS Orthopaedics Guidelines Lead
Mr. Mark Norton, Consultant Orthopaedic Surgeon and Clinical Director, Royal Hospitals Cornwall NHS Trust
Mr Tim Powell, Advanced Practice Orthopaedic Physiotherapist, Cornwall Partnership Foundation NHS Trust
Mrs Jane Mitchell, Lead Professional Extended Scope Physiotherapist, Cornwall Partnership Foundation NHS Trust
References
1. Pain Arising From The Hip In Adults. British Orthopaedic Association, British Hip Society and Royal College of Surgeons Commissioning Guide, 2017
2. Hip Impingement Syndrome Policy. Kernow Clinical Commissioning Group, August 2017
Date reviewed 22/02/2022
Next review due 22/02/2023
Sifter name Dr Rebecca Hopkins
Version No. 1.1