Hip Pathology for General Practice

Richard Freeman FRCS

Eastbourne DGH

October 2013

What I think you want

A brief understanding of the main hip pathologies

What to do with them

How to avoid missing something

How to inject

Topics

Children– Septic hip– DDH– Perthes – Slipped Upper Femoral Epiphysis

Adults– OA– Trochanteric Bursitis

Septic Hip = 0 to 4 yrs

Unwell child Hip held in flexed position Very restricted ROM *Unable to weight bear *Temperature Raised *CRP / ESR / *WCC

*4 = 99% 3= 93% 2= 40% 1= 3% Differential

– Irritable hip– Osteomyelitis

DDH = 0 to 2 yrs

Clicky hips 20/1000 True DDH 2/1000 Risk factors

– Female– Packaging – 1st, breach, twins, etc. – Family History

First 6 weeks is crucial– Ortolani and Barlow– USS / refer

Perthes = 4 to 10 yrs

Small for age, smoking, ADHD Limp often painless Limited abduction Outpatients

SUFE = 11 to 16yrs

KNEE pain KNEE pain KNEE pain Hip pain Normally not traumatic Limp Send to A&E

OA

Diagnosis– Hx– Exam– Is it hip / nerve root / knee

Treatment– Physio, stick, analgesia– THR

Trochanteric Bursitis

Lateral hip pain– Tight muscles– Gluteal tears

Treatment– Injection AND Physio– Relieves pain to allow strength and stretch– 3 to 6 months– If ongoing refer

Young Adult

Known pathology– Old Perthes or DDH– May be able to prevent OA with surgery

The rest– Tight muscles– Labral tears– Rare stuff – tumour, endometriosis etc.

How to inject

Asepsis Long acting local anaesthetic (Bupivicaine

0.5%) Steroid 40-80mg Depomedrone /

Trimacinalone

Take home message

KNEE pain, KNEE pain….

Think about the age of the patient

DON’T give antibiotics unless unwell

Thank you for listening

Any Questions?