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Hip Pathology for General Practice Richard Freeman FRCS Eastbourne DGH October 2013.

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Presentation on theme: "Hip Pathology for General Practice Richard Freeman FRCS Eastbourne DGH October 2013."— 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 – 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 – 1 st, 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 – Hx – Exam – Is it hip / nerve root / knee Treatment – 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 – 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

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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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