Pain following joint replacement- Adult Leeds

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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

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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

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4.  Red Flags

Quick info:

GP information

This pathway does not refer to the management of immediate complications of hip replacement surgery which can include wound infection/haematoma, DVT/PE, nerve damage etc, but clearly vigilance is required if a patient presents with problems shortly after replacement surgery.

There are three main medium- to long-term complications to look out for in assessing a patient following hip replacement surgery:

  • Symptoms of increasing pain and/ or fever soon after surgery may be due to deep infection (approximately 1/100) and will likely require removal of the prosthesis with repeat surgery delayed for several weeks.
  • Dislocation of the hip is fairly dramatic when it happens and occurs in less than 1/20 cases requiring appropriate orthopaedic intervention, either relocation, bracing or further surgery.
  • Instability / giving way / increasing pain may occur years after the replacement, and may be due to loosening or wearing of the prosthesis.

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5.  Assess Patient

Quick info:
GP information
When assessing a patient with hip pain following replacement surgery, the following points should be considered:

  • When was the replacement performed?
  • Exclude immediate post surgical complications – outside the scope of this pathway, including superficial wound infection / DVT/ PE / nerve damage etc.
  • If recent surgery, is there a history of increasing pain and/or fever suggestive of possible deep infection requiring immediate orthopaedic review?
  • Does the patient present with altered gait and increasing pain, or is there a clinical suspicion of prosthetic dislocation requiring immediate orthopaedic assessment?
  • If surgery occurred years ago, could prosthetic failure be the cause, either due to loosening of the prosthesis or wear and tear of the prosthesis. Is there a history of increasing pain, feelings of instability or giving way?

If following assessment there is clinical suspicion that the prosthesis is the cause of the symptoms and there is no requirement for immediate orthopaedic assessment, then an X-ray should be obtained. If the result of the X-ray supports this clinical suspicion then referral is indicated, ideally to the surgeon who replaced the joint.

If the assessment does not suggest the replacement is the cause of the pain, then there is no need for an X-ray to be obtained and the patient should be managed according to the likely aetiology of the problem. If the X-ray is obtained and satisfactory, then the patient should be managed according to the likely aetiology of the problem.

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10. Joint replacement still likely cause. Refer (ideally original)Surgeon Referral Form (MSK3)

Quick info:
Referral Form:
MSK 3 Hip Pain Post Replacement V3

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

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

  • LTHT
  • 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 general exclusion criteria)
  • anaesthetic risk
  • previous anaesthetic complication
  • significant co-morbidity
  • severe psychiatric morbidity

Please see Choose & Book Directory of service for additional information.
Please note patients can be referred to a named clinician through the Choose & Book.

Key Dates

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

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References

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

 Reference

  1. 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.

  2. Adebajo A. ABC of rheumatology: Fourth edition. Chichester: John Wiley and Sons Ltd; 2010.

  3. Map of Medicine (MoM) Clinical Editorial Team and Fellows. London: MoM; 2011.

  4. 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

  5. PRODIGY. Osteoarthritis. Version 1.6. Newcastle upon Tyne: PRODIGY; 2008. http://prodigy.clarity.co.uk/osteoarthritis

  6. American College of Radiology (ACR). Chronic hip pain. American College of Radiology 2008; http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonMusculoskeletalImaging/ChronicHipPainDoc8.aspx
  7. 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

  8. British Pain Society (BPS). Opioids for persistent pain: good practice. British Pain Society 2010; http://www.britishpainsociety.org/book_opioid_main.pdf

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