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Hip Pathology for General Practice

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Presentation on theme: "Hip Pathology for General Practice"— Presentation transcript:

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?

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