1. Hip Pathology for General Practice
Richard Freeman FRCS
Eastbourne DGH
October 2013

2. 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

3. Topics Children Adults Septic hip DDH Perthes
Slipped Upper Femoral Epiphysis
Adults OA
Trochanteric Bursitis

4. 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

5. 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

6. Perthes = 4 to 10 yrs Small for age, smoking, ADHD Limp often painless
Limited abduction
Outpatients

7. SUFE = 11 to 16yrs KNEE pain Hip pain Normally not traumatic Limp
Send to A&E

8. OA Diagnosis Treatment Hx Exam Is it hip / nerve root / knee
Physio, stick, analgesia
THR

9. 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

10. Young Adult Known pathology The rest Old Perthes or DDH
May be able to prevent OA with surgery
The rest
Tight muscles
Labral tears
Rare stuff – tumour, endometriosis etc.

11. How to inject Asepsis Long acting local anaesthetic (Bupivicaine 0.5%)
Steroid 40-80mg Depomedrone / Trimacinalone

14. Take home message KNEE pain, KNEE pain….
Think about the age of the patient
DON’T give antibiotics unless unwell

15. Thank you for listening
Any Questions?