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Hip Pathology for General Practice
Richard Freeman FRCS
Eastbourne DGH
October 2013
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
Topics
Children– Septic hip– DDH– Perthes – Slipped Upper Femoral Epiphysis
Adults– OA– Trochanteric Bursitis
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
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
Perthes = 4 to 10 yrs
Small for age, smoking, ADHD Limp often painless Limited abduction Outpatients
SUFE = 11 to 16yrs
KNEE pain KNEE pain KNEE pain Hip pain Normally not traumatic Limp Send to A&E
OA
Diagnosis– Hx– Exam– Is it hip / nerve root / knee
Treatment– Physio, stick, analgesia– THR
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
Young Adult
Known pathology– Old Perthes or DDH– May be able to prevent OA with surgery
The rest– Tight muscles– Labral tears– Rare stuff – tumour, endometriosis etc.
How to inject
Asepsis Long acting local anaesthetic (Bupivicaine
0.5%) Steroid 40-80mg Depomedrone /
Trimacinalone
Take home message
KNEE pain, KNEE pain….
Think about the age of the patient
DON’T give antibiotics unless unwell
Thank you for listening
Any Questions?