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Young Adult Hip Pain

 

Red Flags

Send to Emergency Department or discuss with Orthopaedic Registrar on call RCHT, not community hospital/minor injury clinics

  • Severe hip pain and sudden inability to weight bear +/- history of fall 
  • 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

 

After excluding red flags consider

  • Femoral acetabular impingement
  • Hip dysplasia
  • Osteoarthritis
  • Trochanteric bursitis
  • Tendinopathies affecting the adductors, psoas and hamstrings
  • Referred pain

This list is not exhaustive


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

Up to date X ray within 12 months

Please note the use of MRI for the investigation of hip pain is not commissioned in Primary Care.3


If concern regarding suspected new malignancy please refer via Fast track suspected cancer route.

  • X ray suggests the possibility of Sarcoma
  • Myeloma work up
  • Common metastases to bone: Prostate, breast, renal, lung, thyroid  
  • Please include information on their previous treatment and prognosis   
  • Fast track suspected cancer or oncology if known primary

 

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

http://rms.kernowccg.nhs.uk/primary_care_clinical_referral_criteria/primary_care_clinical_referral_criteria/rheumatology/inflammatory_arthritis

 

Femoral Acetabular Impingement

Conservative Measures

  • Analgesia
  • Reduce pain provocating/inducing activities
  • Three months of supervised physiotherapy

 

Information Required Before Referral

Up to date X ray within 12 months

Please note the use of MRI for the investigation of hip pain is not commissioned in Primary Care.3

MRI arthrograms are not indicated in Primary Care, requested by hip surgeon only

 

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

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



 

 

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.  Cornwall and IoS Commissioning Policy and Evidence Based Interventions.

3.    MRI Scan of the hip for arthritis (National Evidence Based Intervention). Cornwall and IoS Commissioning Policy and Evidence Based Interventions.

 

 

 

Page Review Information

Date reviewed       13 May 2025 Partial update

Next review due    13 May 2026

Sifter name            Dr Rebecca Hopkins

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

 

 

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