{"id":24555,"date":"2025-07-09T13:01:52","date_gmt":"2025-07-09T12:01:52","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=24555"},"modified":"2026-06-10T08:17:43","modified_gmt":"2026-06-10T07:17:43","slug":"adult-non-arthritic-hip-service","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/","title":{"rendered":"Adult Non Arthritic Hip Service"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Introduction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Adult Non Arthritic Hip Service (ANAH) has been set up to improve the management of patients with hip pain who do <strong>NOT<\/strong> 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Referrals are triaged electronically by one of the clinicians prior to be placed on the ANAH out patient waiting list as Urgent or Routine.&nbsp; Advice can also be offered to the referring practitioner.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This Ref Help guide is divided into sections based on the <strong>predominant<\/strong> site of the patient\u2019s symptoms and provides guidance on diagnosis, primary care management and referral to secondary care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/groin-pain-2\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/groin-pain-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">Groin pain <\/a><\/span>(or <em>predominantly <\/em>groin pain)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please note that OA or early OA is the most likely diagnosis in patients who present with groin pain.\u00a0 If OA is seen on XR \u2013 AP pelvis, refer to<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/arthroplasty\/\" target=\"_blank\" rel=\"noreferrer noopener\"> Arthroplasty service<\/a><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"299\" height=\"448\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-1.png\" alt=\"ANAH 1\" class=\"wp-image-24560\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-1.png 299w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-1-200x300.png 200w\" sizes=\"auto, (max-width: 299px) 100vw, 299px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/lateral-hip-pain\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/lateral-hip-pain\/\" target=\"_blank\" rel=\"noreferrer noopener\"><span style=\"text-decoration: underline\">Lateral hip pain<\/span> <\/a>(or <em>predominantly <\/em>lateral hip pain)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These patients will rarely need referred to secondary care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Referral to physiotherapy in first instance<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"589\" height=\"391\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-2.png\" alt=\"ANAH Services 2\" class=\"wp-image-24561\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-2.png 589w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-2-300x199.png 300w\" sizes=\"auto, (max-width: 589px) 100vw, 589px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/buttock-pain-2\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/buttock-pain-2\/\" target=\"_blank\" rel=\"noreferrer noopener\"><span style=\"text-decoration: underline\">Buttock pain<\/span><\/a> (or <em>predominantly<\/em> buttock pain)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most cases of buttock pain are due to osteoarthritis or referred pain from the lumbar spine.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Consider referral to physiotherapy for assessment of these patients<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"620\" height=\"457\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-3.png\" alt=\"ANAH Services 3\" class=\"wp-image-24562\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-3.png 620w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-3-300x221.png 300w\" sizes=\"auto, (max-width: 620px) 100vw, 620px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\"><strong>Red Flags for groin, lateral hip or buttock pain include:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Inguinal\/femoral hernia<\/li>\n\n\n\n<li>Post hernioplasty pain<\/li>\n\n\n\n<li>Nerve entrapment \u2013 obturator, ilioinguinal, genito femoral, iliohypogastric<\/li>\n\n\n\n<li>Apophysitis\/avulsion # &#8211; ASIS, AIIS, Pubic bone<\/li>\n\n\n\n<li>Stress # &#8211; NOF, pub ramus, acetabulum<\/li>\n\n\n\n<li>Hip joint \u2013 Avascular necrosis (AVN)<strong>*<\/strong>, Perthes disease, transient osteoporosis head of femur<\/li>\n\n\n\n<li>Hip joint (adolescents) slipped cap fem epiphysis,<\/li>\n\n\n\n<li>Arthritis of hip joint \u2013 transient or infectious<\/li>\n\n\n\n<li>Inguinal lymphadenopathy<\/li>\n\n\n\n<li>Intra abdominal \u2013 prostatitis, UTI, kidney stone, appendicitis, diverticulitis<\/li>\n\n\n\n<li>Gynaecological conditions and tumours<\/li>\n\n\n\n<li>Spondyloarthropathies \u2013 ankylosing spondylitis<\/li>\n\n\n\n<li>Tumours \u2013 testicular, bone, prostate ca, urinary tract ca, digestive tract ca, soft tissue tumours<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>*Avascular necrosis (AVN)<\/strong> 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 <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/arthroplasty\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/arthroplasty\/\" target=\"_blank\" rel=\"noreferrer noopener\">Arthroplasty Hip service<\/a> is indicated with Urgent A-P pelvis XR.<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">GPs, GPAPPs, other Consultants<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Patients without OA on XR who have failed to improve despite at least 3 months of targeted hip specific physiotherapy (see individual sections \u00a0<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/buttock-pain-2\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/buttock-pain-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">Buttock pain<\/a>, <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/groin-pain-2\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/groin-pain-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">\u00a0Groin pain<\/a>, <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/lateral-hip-pain\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/lateral-hip-pain\/\" target=\"_blank\" rel=\"noreferrer noopener\">Lateral Hip Pain<\/a>).<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">If OA is seen on XR \u2013 AP pelvis, refer to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/arthroplasty\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/arthroplasty\/\" target=\"_blank\" rel=\"noreferrer noopener\">Arthroplasty<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u00a0Red flags for groin pain: <em>see home page<\/em><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fapps.nhslothian.scot%2Frefhelp%2Fguidelines%2Forthopaedics%2Fadult-non-arthritic-hip-service%2F&amp;data=05%7C02%7Cmaria.mazoysaavedra%40nhs.scot%7C540c12169f894f238b0108dec6540ab1%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C639166261732936246%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=Umvr6MPW48CBXJ44rfm016qeZiNe4hqcn8I5EdJzl7Q%3D&amp;reserved=0\">\u00a0<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Adult Non Arthritic Hip Service \u2013 RefHelp<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics \u2013 Hip &gt; LI Adult Non Arthritic Hips&nbsp;<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4220,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1266],"class_list":["post-24555","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-adult-non-arthritic-hip-service"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/orthopaedics\/https-apps-nhslothian-scot-refhelp-adult-non-arthritic-hip-service\/\" rel=\"tag\">Adult Non Arthritic Hip Service<\/a>","rttpg_excerpt":"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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24555","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=24555"}],"version-history":[{"count":12,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24555\/revisions"}],"predecessor-version":[{"id":28300,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24555\/revisions\/28300"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4220"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=24555"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=24555"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}