What are the indications for referring an adult with hip pain to secondary care for further evaluation?

Indications for referring an adult with hip pain to secondary care for further evaluation include:

• Severe hip pain that is unresponsive to analgesia and persistent loss of function requiring urgent orthopaedic referral.
• Persistent hip pain in people under 40 years that affects daily activities, work, or leisure and has not improved after a 3-month course of physiotherapy.
• Hip pain that is painful, irritable, and stiff, interfering with sleep, activities of daily living, work, or leisure, and not controlled with conservative measures.
• Symptoms possibly related to previous hip surgery or a fractured femur.
• Diagnostic uncertainty about the cause of hip pain.
• No response to peri-trochanteric corticosteroid injection and/or physiotherapy when such treatments have been attempted.
• Suspected osteoarthritis with symptoms substantially impacting quality of life, diagnostic uncertainty, atypical features, or ineffective/non-tolerated initial management strategies after 3 months.
• Sudden worsening of hip symptoms.
• New or worsening pain, limp, or loss of function related to a previous hip joint replacement.
• Suspected serious pathology such as tumour, osteonecrosis, or inflammatory arthritis requiring urgent specialist assessment.

Further assessment in secondary care may include advanced imaging (ultrasound, MRI, CT) and specialist interventions such as surgical procedures or specialist injections.

Referral decisions should be made before prolonged and established functional limitation and severe pain develop, and comorbidities should be optimised prior to referral where possible.

References: ¹,²,⁴,⁶