Hip

 

Aims of the Hip Pathway:

  • To improve patient access earlier in their treatment pathway to options and alternatives to surgery as well as on likely outcomes 
  • To ensure patients who require surgery are appropriately referred and given preoperative care
  • To allow patients to fully participate in decisions about their care
  • To offer better pre-operative preparation through physiotherapy which helps patients to better manage their condition and/or prepare for surgery as well as reducing post-operative recovery times and improving post operative outcomes
  • To ensure that the patients who are referred into secondary care are suitable and ready for surgery and properly prepared so as to enjoy the best possible outcomes 
  • To ensure more joined up holistic working between primary care , physiotherapy services and secondary care 

Quick Note: 

Please note that this service is for patients surgical and non surgical management of hip pain

Management options are discussed with the patient at their initial assessment and should surgery be required they will be referred immediately to their chosen secondary care location. They will also receive pre-operative preparation whilst awaiting their hospital appointment to ensure that by the times they see the orthopaedic consultant they are fully prepared for surgery.

All of the assessments are undertaken by our senior physiotherapists who have specific training and expertise in musculoskeletal and are able to assess and diagnosis hip pathologies and refer on appropriately.

Management in primary Care:

Initial management strategies for patients with osteoarthritis of the hip include:

  • Reassurance and patient education
  • Weight reduction in patients who are obese (BMI>35). These patients should be referred to their local weight management service
  • Advise about appropriate walking aids 
  • Patient specific exercise programmes (please see OA Hip )
  • Advise on cushioned/supportive footwear
  • Advise on medication which should typically include analgesics and non steroidal anti-inflammatories 

Referral Criteria:

  • Hip pain that can no longer be managed with simple analgesia and basic physiotherapy 
  • X-Ray evidence of established OA of the hip

How to access the service:

Response times & Prioritisation:

All hip patients referred into this service will be seen and assessed by a senior Physiotherapists within 3 weeks of us receiving a referral 

The patient will start their programme of care within 3 weeks of their assessment if referred to stage 1 and if referred to stage 2 a referral to secondary care will be sent that day

Programme stage 1 – Conserative Management:

This is for patients with moderate or established osteoarthritis who require conservative management

The patient will either be seen as a 1:1 or 5, 1.5 hour group sessions which will cover the following :

  • General fitness and flexibility
  • Strength and mobility exercises (as supported by the NICE guidelines)
  • Weight loss and dietary advice
  • Pain control and management including pain DVD
  • Smoking cessation
  • Discussion and video footage with expert patient 
  • Discussion re equipment and walking aids if required

The patient is then re-assessed on completion of their 4th session to re-evaluate their goals and outcome measures

Their physiotherapist will also contact them again at 1 and 3 months after this appointment for a telephone review

You will be kept informed of their progress throughout the program 

Programme Stage 2 – Preparation for Surgery:

  • The focus of stage 2 is to prepare the patient for surgery and refer them to their chosen secondary care location
  • They will receive an initial assessment within 3 weeks of us receiving the referral 
  • They will be referred onto secondary care after the initial assessment and receive 3, 1:1 sessions in preparation for their operation 
  • You will be informed of what is happening and receive a copy of the orthopaedic referral and where it has been sent 

Objective Measures:

  • All patients entering the pathway will complete an EQ5D and an Oxford Hip Score
  • This is repeated again once they are discharged from the service
  • We also use a patient satisfaction survey to gain patient feedback on the service and the results of this are reported on regularly

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