Introduction
The Adult Non Arthritic Hip Service (ANAH) has been set up to improve the management of patients with hip pain who do NOT have osteoarthritis. It is staffed by Consultant Orthopaedic Surgeons with a special interest in patients with hip conditions and in hip arthroscopy and an Extended Scope Practitioner.
Referrals are triaged electronically by one of the clinicians prior to be placed on the ANAH out patient waiting list as Urgent or Routine. Advice can also be offered to the referring practitioner.
This Ref Help guide is divided into sections based on the predominant site of the patient’s symptoms and provides guidance on diagnosis, primary care management and referral to secondary care.
It is acknowledged that patients with pain in these areas can be difficult to assess. Please consider a referral to physiotherapy to help with assessment and treatment.
Groin pain (or predominantly groin pain)
Please note that OA or early OA is the most likely diagnosis in patients who present with groin pain. If OA is seen on XR – AP pelvis, refer to Arthroplasty service
Lateral hip pain (or predominantly lateral hip pain)
These patients will rarely need referred to secondary care.
Referral to physiotherapy in first instance
Buttock pain (or predominantly buttock pain)
Most cases of buttock pain are due to osteoarthritis or referred pain from the lumbar spine.
Consider referral to physiotherapy for assessment of these patients
Red Flags for groin, lateral hip or buttock pain include:
- Inguinal/femoral hernia
- Post hernioplasty pain
- Nerve entrapment – obturator, ilioinguinal, genito femoral, iliohypogastric
- Apophysitis/avulsion # – ASIS, AIIS, Pubic bone
- Stress # – NOF, pub ramus, acetabulum
- Hip joint – Avascular necrosis (AVN)*, Perthes disease, transient osteoporosis head of femur
- Hip joint (adolescents) slipped cap fem epiphysis,
- Arthritis of hip joint – transient or infectious
- Inguinal lymphadenopathy
- Intra abdominal – prostatitis, UTI, kidney stone, appendicitis, diverticulitis
- Gynaecological conditions and tumours
- Spondyloarthropathies – ankylosing spondylitis
- Tumours – testicular, bone, prostate ca, urinary tract ca, digestive tract ca, soft tissue tumours
*Avascular necrosis (AVN) of the femoral head is a condition caused by disrupted blood supply leading to bone cell death and eventual collapse of the femoral head. It typically presents with a gradual onset of dull, aching pain in the groin, thigh, or buttock, often without clear risk factors, though corticosteroid use and alcohol misuse are common contributors. In early stages, physical examination may be normal, but as the disease progresses, hip movement becomes increasingly restricted and painful. Diagnosis is confirmed radiologically. Urgent referral to Arthroplasty Hip service is indicated with Urgent A-P pelvis XR.
