Leeds Health Pathways

Hip Osteoarthritis- Adult Leeds

1. Information Resources for Patients and Carers

Quick info:
Patient information:
See attached patient information leaflet for groin strain.

See attached patient information leaflet for lateral hip pain.

See attached patient information leaflet for trochanteric bursitis

Patient Information Leaflet Surgery BMI over 35

Hip Replacement Patient Information Leaflet

See attached patient information leaflet for osteoarthritis of the hip.

It is good practice to give patients written material to read whilst they decide whether to go ahead with hip replacement. Please use the attached abridged patient information leaflet or the comprehensive patient information leaflet available from Arthritis Research UK.

A decision aid can also be accessed online: Decision Aid for Hip Replacement

2. Referral Forms

Quick info:
Referral Forms

Quick View - PDF
MSK 1 Hip Form V3
MSK 2 Hip Replacement Form V3
MSK 3 Hip Pain Post Replacement V3
MSK14 Problem Not on Pathway Form V3

Mail Merged
The forms below are provided as a repository. They can be downloaded to your computer and be imported to your clinical system. This is so all practices have access to the most up to date forms.

EMIS - merged
MSK 1 Hip Form V3
MSK 2 Hip Replacement Form V3
MSK 3 Hip Pain Post Replacement V3
MSK14 Problem Not on Pathway Form V3

SystmOne - merged
MSK 1 Hip Form V3
MSK 2 Hip Replacement Form V3
MSK 3 Hip Pain Post Replacement V3
MSK14 Problem Not on Pathway Form V3

5. Web Based Patient Decision Aid

Quick info:
Patient information
Decision Aid for Hip Replacement

GP information

The link above to the NHS / BMJ Group Shared Decision Making website may assist when discussing with patients whether or not a referral for hip replacement is appropriate.

6. Non-Surgical Management

Quick info:
Patient Information
See attached patient information leaflet for osteoarthritis of the hip.

GP information
If the patient is unsuitable or declines surgery, alternative management options for hip osteoarthritis include:

adequate analgesia
weight loss where appropriate, consider suitability for weight management service referral
Tier 1 physiotherapy – benefit only likely to be seen for short term one-off intervention in younger cohort
falls team assessment – consider if appropriate for older age group at risk of falls for multi-disciplinary intervention with OT/physiotherapy input

7. Meets Criteria for Hip Replacement

Quick info:
Patient information

Decision Aid for Hip Replacement

It is good practice to give patients written material to read whilst they decide whether to go ahead with hip replacement. Please use the attached abridged patient information leaflet or the comprehensive patient information leaflet available from Arthritis Research UK.

Hip Replacement
Patient Information Leaflet

GP information
Before referring for consideration of hip replacement surgery please check that the patient meets the following criteria:

willing and motivated to undergo surgery
medically fit for surgery
sufficiently severe – please consider, for example:
- has appropriate and adequate analgesia been prescribed?
- is there nocturnal pain, and subsequent sleeplessness?
- is pain and reduced range of movement present on examination?
- are activities of daily living affected?
- are activities pursued for enjoyment affected?
- have conservative treatment options been discussed and exhausted?

10. BMI ≥ 35

Quick info:
Patient Information Leaflet Surgery BMI over 35

Hip Replacement Patient Information Leaflet

11. BMI < 35

Quick info:
Patient Information Leaflet Surgery BMI over 35

Hip Replacement Patient Information Leaflet

13. Refer Hip Replacement Surgery Referral Form (MSK2)

Quick info:
Referral Form:
MSK 2 Hip Replacement Form V3

Choose and Book
You can find this clinic on Choose and Book under:
Speciality: Orthopaedics
Clinic Type: Hip Pain

Pathway information
Patients being referred for a hip replacement will no longer be triaged by the Musculoskeletal Service.

The triage system for hip replacement has been very effective in ensuring only those patients who need and want a hip replacement see a surgeon.

The crude measurement of success is the "conversion rate" of first out patient attendances that go to have surgery. Currently the musculoskeletal service achieves 65%.

On reviewing this pathway it was felt the GPs would be able to achieve the same conversion rate. Individual GPs will be provided with their own conversion rate as part of peer review data.

GP Information
Patients with BMI < 35 meeting the criteria for hip replacement should be referred directly to a provider.

Provider information
Common providers of this procedure to Leeds patients include:

LTHT
Nuffield - please note, exclusions apply
Spire - please note, exclusions apply
Yorkshire Clinic - please note, exclusions apply
BRI
Harrogate
Mid Yorks
Calderdale Royal Infirmary

Where exclusions apply common exclusions include:

BMI >35 (please note this is a general exclusion criteria)
anaesthetic risk
previous anaesthetic complication
significant co-morbidity
severe psychiatric morbidity
revision surgery (please see 'Hip pain following joint replacement' page of this pathway) Please see Choose & Book Directory of service for additional information.

14. Age<65

Quick info:
GP information

For patients < 65 years of age with a BMI > 35 meeting the criteria for hip replacement surgery, a weight loss target over a set period of time (months) should be agreed with the patient before considering referral for hip replacement.

This can be individualised between the GP and the patient, and may (but does not have to) include referral to a weight management service. The rationale for this includes an increased failure rate and complication rate associated with hip replacement procedures in those with high BMI's.

If the individualised agreed weight loss target is achieved then referral for a hip replacement is indicated.

If the weight loss target is not achieved then the increased failure rate and complication rate associated with hip replacement procedures in those with high BMI' s should be discussed with the patient. The patient should be provided with the information leaflet explaining these issues.

If the patient is fully informed, accepts the potential risks and remains keen to be referred for hip replacement surgery then referral is indicated. Please do not refer patients who are undecided and may not wish to proceed with surgery.

15. Age ≥ 65

Quick info:
GP information
For patients ≥ 65 years of age with a BMI ≥ 35 meeting the criteria for hip replacement surgery, it has been agreed locally that weight loss targets may be unrealistic.

The increased failure rate and complication rate associated with hip replacement procedures in those with high BMI' s should be discussed with the patient. The patient should be provided with the information leaflet explaining these issues.

16. Refer Tier 1 Physiotherapy Referral Form (MSK1)

Quick info:
Referral Form:
MSK 1 Hip Form V3

Choose & BookYou can find this clinic on Choose & Book under:
Speciality: Physiotherapy
Clinic Type:Musculoskeletal

Provider information
The only provider of Tier 1 physiotherapy in the city is the Leeds Musculoskeletal Service. This service is directly bookable via Choose and Book. Please complete the appropriate form and send via Choose and Book.

If symptoms persist, referral to Tier 1 physiotherapy is appropriate, who will refer onward to MSK-MDT if symptoms persist or there is diagnostic doubt.

17. Discuss Increased Risk and give patient information leaflet

Quick info:
A decision aid can also be accessed online: Decision Aid for Hip Replacement

Patient Information Leaflet Surgery BMI over 35

Hip Replacement
Patient Information Leaflet

18. Agree weight loss goal

Quick info:

Patient Information Leaflet Surgery BMI over 35

Hip Replacement
Patient Information Leaflet

20. Refer Hip Replacement Surgery Referral Form (MSK2)

Quick info:
Referral Form:
MSK 2 Hip Replacement Form V3

Choose and Book
You can find this clinic on Choose and Book under:
Speciality: Orthopaedics
Clinic Type: Hip Pain

Pathway information
Patients being referred for a hip replacement will no longer be triaged by the Musculoskeletal Service.

The triage system for hip replacement has been very effective in ensuring only those patients who need and want a hip replacement see a surgeon.

The crude measurement of success is the "conversion rate" of first out patient attendances that go to have surgery. Currently the musculoskeletal service achieves 65%.

On reviewing this pathway it was felt the GPs would be able to achieve the same conversion rate. Individual GPs will be provided with their own conversion rate as part of peer review data.

GP Information
Patients meeting the criteria for hip replacement should be referred directly to a provider.

Provider information
Common providers of this procedure to Leeds patients include:

LTHT
Nuffield - please note, exclusions apply
Spire - please note, exclusions apply
Yorkshire Clinic - please note, exclusions apply
BRI
Harrogate
Mid Yorks
Calderdale Royal Infirmary

Where exclusions apply common exclusions include:

BMI >35
anaesthetic risk
previous anaesthetic complication
significant co-morbidity
severe psychiatric morbidity
revision surgery (please see 'Hip pain following joint replacement' page of this pathway) Please see Choose & Book Directory of service for additional information.

21. Goal Achieved

Quick info:
Patient Information Leaflet Surgery BMI over 35

Hip Replacement
Patient Information Leaflet

22. Goal Not Achieved

Quick info:
Patient Information Leaflet Surgery BMI over 35

Hip Replacement
Patient Information Leaflet

23. Patient accepts risk and wishes to proceed with referral

Quick info:
Patient Information Leaflet Surgery BMI over 35

Hip Replacement
Patient Information Leaflet

24. Provide Pre-Op Hip Replacement Patient Information Leaflet

Quick info:
Patient Information Leaflet Surgery BMI over 35

Hip Replacement
Patient Information Leaflet

abridged patient information leaflet or the comprehensive patient information leaflet available from Arthritis Research UK.

26. Discuss increased risk and give patient information leaflet

Quick info:
A decision aid can also be accessed online: Decision Aid for Hip Replacement

Patient Information Leaflet Surgery BMI over 35

Hip Replacement
Patient Information Leaflet

27. Refer Hip Replacement Surgery Referral Form (MSK2)

Quick info:
Referral Form:
MSK 2 Hip Replacement Form V3

Choose and Book
You can find this clinic on Choose and Book under:
Speciality: Orthopaedics
Clinic Type: Hip Pain

Pathway information
Patients being referred for a hip replacement will no longer be triaged by the Musculoskeletal Service.

The triage system for hip replacement has been very effective in ensuring only those patients who need and want a hip replacement see a surgeon.

The crude measurement of success is the "conversion rate" of first out patient attendances that go to have surgery. Currently the musculoskeletal service achieves 65%.

On reviewing this pathway it was felt the GPs would be able to achieve the same conversion rate. Individual GPs will be provided with their own conversion rate as part of peer review data.

GP Information
Patients meeting the criteria for hip replacement should be referred directly to a provider.

Provider information
Common providers of this procedure to Leeds patients include:

LTHT
Nuffield - please note, exclusions apply
Spire - please note, exclusions apply
Yorkshire Clinic - please note, exclusions apply
BRI
Harrogate
Mid Yorks
Calderdale Royal Infirmary

Where exclusions apply common exclusions include:

BMI >35
anaesthetic risk
previous anaesthetic complication
significant co-morbidity
severe psychiatric morbidity
revision surgery (please see 'Hip pain following joint replacement' page of this pathway) Please see Choose & Book Directory of service for additional information.

28. Patient accepts risk and wishes to proceed with referral

Quick info:
Patient Information Leaflet Surgery BMI over 35

Hip Replacement
Patient Information Leaflet

29. Refer Hip Replacement Surgery Referral Form (MSK2)

Quick info:
Referral Form:
MSK 2 Hip Replacement Form V3

Choose and Book
You can find this clinic on Choose and Book under:
Speciality: Orthopaedics
Clinic Type: Hip Pain

Pathway information
Patients being referred for a hip replacement will no longer be triaged by the Musculoskeletal Service.

The triage system for hip replacement has been very effective in ensuring only those patients who need and want a hip replacement see a surgeon.

The crude measurement of success is the "conversion rate" of first out patient attendances that go to have surgery. Currently the musculoskeletal service achieves 65%.

On reviewing this pathway it was felt the GPs would be able to achieve the same conversion rate. Individual GPs will be provided with their own conversion rate as part of peer review data.

GP Information
Patients meeting the criteria for hip replacement should be referred directly to a provider.

Provider information
Common providers of this procedure to Leeds patients include:

LTHT
Nuffield - please note, exclusions apply
Spire - please note, exclusions apply
Yorkshire Clinic - please note, exclusions apply
BRI
Harrogate
Mid Yorks
Calderdale Royal Infirmary

Where exclusions apply common exclusions include:

BMI >35
anaesthetic risk
previous anaesthetic complication
significant co-morbidity
severe psychiatric morbidity
revision surgery (please see 'Hip pain following joint replacement' page of this pathway) Please see Choose & Book Directory of service for additional information.

31. Refer Hip Replacement Surgery Referral Form (MSK2)

Quick info:
Referral Form:
MSK 2 Hip Replacement Form V3

Choose and Book
You can find this clinic on Choose and Book under:
Speciality: Orthopaedics
Clinic Type: Hip Pain

Pathway information
Patients being referred for a hip replacement will no longer be triaged by the Musculoskeletal Service.

The triage system for hip replacement has been very effective in ensuring only those patients who need and want a hip replacement see a surgeon.

The crude measurement of success is the "conversion rate" of first out patient attendances that go to have surgery. Currently the musculoskeletal service achieves 65%.

On reviewing this pathway it was felt the GPs would be able to achieve the same conversion rate. Individual GPs will be provided with their own conversion rate as part of peer review data.

GP Information
Patients meeting the criteria for hip replacement should be referred directly to a provider.

Provider information
Common providers of this procedure to Leeds patients include:

LTHT
Nuffield - please note, exclusions apply
Spire - please note, exclusions apply
Yorkshire Clinic - please note, exclusions apply
BRI
Harrogate
Mid Yorks
Calderdale Royal Infirmary

Where exclusions apply common exclusions include:

BMI >35
anaesthetic risk
previous anaesthetic complication
significant co-morbidity
severe psychiatric morbidity
revision surgery (please see 'Hip pain following joint replacement' page of this pathway) Please see Choose & Book Directory of service for additional information.

Key Dates
Published: 09-Oct-2015, by Leeds
Valid until: 17-Jun-2016

References

This is a list of all the references that have passed critical appraisal for use in the care map MSK - Hip pain

Reference

Cibulka MT, White DM, Woehrle J et al. Hip pain and mobility deficits - Hip Osteoarthritis: . Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2009; 39: A1-25.
Adebajo A. ABC of rheumatology: Fourth edition. Chichester: John Wiley and Sons Ltd; 2010.
Map of Medicine (MoM) Clinical Editorial Team and Fellows. London: MoM; 2011.
British Pain Society (BPS). A practical guide to the provision of Chronic Pain Services for adults in Primary Care. British Pain Society 2011; http://www.britishpainsociety.org/NAPP_RESOURCEPACK.pdf
PRODIGY. Osteoarthritis. Version 1.6. Newcastle upon Tyne: PRODIGY; 2008. http://prodigy.clarity.co.uk/osteoarthritis
American College of Radiology (ACR). Chronic hip pain. American College of Radiology 2008; http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonMu sculoskeletalImaging/ChronicHipPainDoc8.aspx
National Health and Medical Research Council (NHMRC). Evidence-based management of acute musculoskeletal pain. National Health and Medical Research Council 2003; http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp94.pdf
British Pain Society (BPS). Opioids for persistent pain: good practice. British Pain Society 2010; http://www.britishpainsociety.org/book_opioid_main.pdf