Information for GPs

Red flags and urgent referrals
Urgent referral to Orthopaedics by telephone to a hip specialist for the following symptoms:

  • Unable to walk
  • Trauma
  • Unable to move hip
  • Septic/unwell
  • Systemic symptoms
  • Signs of infection
  • Known primary malignancy
  • Raised inflammatory markers
  • Severe muscle spasm
  • Sudden deterioration of chronic hip pain

GP diagnostic triage

FBC, LFT, CRP, plasma viscosity, bone profile,RFT, PSA  Recommended primary care medical management should include:

  • Analgesia (see local Joint Formulary for details)
  • Advise to use a walking stick
  • Advise to reduce weight if obese
  • Consider x-ray if diagnosis uncertain or if confirmation required (AP pelvis)
  • Consider referral to Physiotherapist if functionally impaired

Specific Diagnoses


Primary care action

  • Analgesia (see local Joint Formulary for details)
  • NSAIDS plus PPI
  • See NICE guidance for further advice
  • Consider Orthopaedic referral for Avascular Necrosis (AVN)
  • Referral to Rheumatologist or Orthopaedic surgeon


a) Soft tissue (eg trochanteric bursitis)
Pain and tenderness on palpation directly over the superoposterior aspect of the greater trochanter
Weakness/pain on resisted abduction
Consider injection and referral to Physiotherapist
Referral to Orthopaedic surgeon
b) Osteoarthritis
Patient presents with groin or buttock pain which is worse on weight bearing
Range of movement is affected, in particular medial/internal rotation, flexion and abduction and activities of daily living
Referral to Physiotherapist or Occupational Therapist for appropriate aids
Referral to an Orthopaedic Surgeon
c) Young adult hips
Young adult hip problems include:
Patients less than 50 years old and older than 18 years
Old Perthes
Slipped upper femoral epithysis
Congenital dislocation of the hip
OA and AVN
Labral tear
Snapping ilio-tibial band
Femoroacetabular impingement (FAI)

Diagnostic tests:

X-ray where indicated – standing AP pelvis and cross table laterals  Referral to Musculoskeletal service

Painful THR

X-ray where indicated standing AP pelvis and cross table lateral
Referral to Orthopaedic Surgeon