tay.generalcomments@nhs.scot

Hip

  • The hip service deals with the management of patients with hip conditions, which might benefit from surgical management, including end stage arthritis, dysplasia (abnormal development), avascular necrosis, soft tissue problems, tumours around the hip and complications after hip surgery. 

General advice

  • Many musculoskeletal conditions presenting with pain around the hip are self-limiting. Flare-ups of arthritis may settle with conservative management.
  • Hip joint pathology typically causes groin pain. Pain in the buttock is likely to be from the spine or sacroiliac joint. 
  • The hip service is happy to accept referrals where the diagnosis of an MSK problem is unclear. Such patients should have appropriate work-up and should have been seen face to face by a Physiotherapist unless there is a suspicion of cancer or infection where referral is required. If onward referral is required this should be completed by the Physiotherapist without further need for GP intervention.
  • Referrals will be vetted and assigned to the most appropriate specialist, Please be aware that this may be an advanced practice Physiotherapist. 
  • Younger adults (less than about 40) with hip / groin pain and without severe pain or limp should have Physiotherapy assessment and minimum 6 months of engagement with Physiotherapy prior to referral. Such patients will be 'flagged to' our specialist Young Adult Hip Surgeon (Mr G Nicol) for review and may then be appointed for Outpatient review. See guidance on Young Adult Hip Problems.
  • Any problem after hip surgery is likely to be vetted for review by the operating surgeon where possible or vetted to the Revision Hip Service. Named referrals to the operating surgeon are appropriate.
  • Where a referred patient may be more appropriately seen by another speciality, the referral may be redirected appropriately.

Primary Care diagnostics

  • Blood tests should be performed if malignancy, polymyalgia rheumatica or inflammatory arthritis are suspected.
  • All patients referred to our hip service should have an AP pelvic x-ray as diagnostic workup.

Who we see

Urgent Suspected Cancer Referrals
Urgent referrals
  • Avascular Necrosis (AVN)
  • Rapidly progressive or severe osteoarthritis
  • Severe pain after joint replacement
  • Severe pain and limp with hip dysplasia on X-ray

Routine referrals
  • End-stage arthritis of the hip for consideration of hip replacement
  • Younger adults with uncontrolled hip pain (not severe, no limp) due to childhood hip disorder (see guidance)
    • Hip Dysplasia (DDH)
    • Perthes
    • SUFE
  • Femoroacetabular impingement (FAI), hip dysplasia and labral tears with pain not responding to conservative management / physiotherapy (see guidance)
  • Problems after hip replacement surgery
    • Pain
    • Dislocation or feelings of instability
    • Severe abductor weakness not improved by physiotherapy
  • Symphyseal-related groin pain refractory to physiotherapy
  • Unexplained hip pain
  • Clicking or snapping hip refractory to physiotherapy

Who not to refer (refer MSK physiotherapy)


There is no good surgical solution for adductor-related groin pain, abdominal wall related groin pain without hernia nor trochanteric hip pain. Physiotherapy is the mainstay of treatment.
 

How to refer

  • Emergency Referrals. For hip injuries or suspected infection, referral for advice or assessment should be made to the on call Orthopaedic Surgery Registrar via the Ninewells switchboard. Bleep 4561
  • Suspected Cancer. For assessment / opinion on tumours or possible cancer, we do not have a specialist tumour clinic. Referrals should be made to the appropriate subspecialty clinic according to the location of the tumour or age of the patient (paediatric patients). Where there is a possibility or suspicion of malignancy, the 'urgent – suspected cancer' priority option should be selected on SCI Gateway or the written referral marked appropriately (see referral guidance on Referrals of Musculoskeletal Tumours).
  • Outpatient referrals or non-urgent advice through SCI Gateway Orthopaedic hip surgery service, flagged as urgent (suspected cancer), urgent, routine or advice.
  • Named Referrals to specific consultant or other clinician may be appropriate if the patient has previously been seen by that clinician for the same problem, however an appointment with that consultant cannot be guaranteed. For referrals regarding a new problem, a named referral request cannot be guaranteed.