How should I approach the management of hip pain in an adult with a history of previous hip surgery?

Approach to managing hip pain in an adult with previous hip surgery:

• Recognise that hip pain after previous surgery may indicate complications or new pathology; therefore, refer to secondary or intermediate care if symptoms persist, especially if pain is severe, unresponsive to analgesia, or there is functional loss.
• Referral is particularly important if the pain could be related to previous hip surgery or fracture, or if the diagnosis is uncertain, as further assessment including imaging (ultrasound, MRI, CT) may be required.
• Initial management in primary care should include conservative measures such as analgesia (paracetamol, NSAIDs if appropriate), advice on activity modification, and physiotherapy focusing on muscle strengthening and load management.
• If conservative treatment fails, consider peri-trochanteric corticosteroid injections if expertise is available; otherwise, refer for specialist injection and further management.
• For patients with osteoarthritis or joint degeneration post-surgery, consider referral to physiotherapy or musculoskeletal teams for tailored exercise programmes and possible occupational therapy for aids and adaptations.
• Referral to orthopaedics should be considered if non-surgical management is ineffective after 3 months, or if there is diagnostic uncertainty, atypical features, or sudden worsening of symptoms.

This approach aligns with the British Orthopaedic Association recommendations and NICE guidance emphasising early referral before severe pain and functional limitation develop, and the need for specialist assessment when previous surgery complicates the clinical picture ¹,².