Informing patients 4: Hip Pain – Benefits and Risks and Treatment Alternatives

An information resource for practitioners

The law on consent require health practitioners to inform patients of the benefits and risks of treatment and alternative treatments.  This article is part of a series to equip practitioners to inform their patients.  It is to be noted that it is difficult to find information on benefits and risks of treatments so please feel free to provide feedback so we can develop this resource.

This list is a generalised list to use a resource and needs to be applied using your osteopathic expertise, based on the patient’s condition, presentation, preferences and understanding.

N.B. this information is written for practitioners with medical knowledge, if you are suffering with shoulder pain please seek advice from a health practitioner.

Hip Pain

Education and activity modification

Weight loss, keeping active, using walking aids as appropriate.  Reassurance about pain, underlying pathology and fact that improvements can be made.

Benefits: low-cost option, possibility of improvement in pain, empowers patient

Risks: Bony changes may mean restricted movement cannot be improved.  Yellow flags may be barriers to improvement

Exercise

Exercise is very important with most hip pathologies, particularly osteoarthritis.  Strengthening and aerobic fitness.

Benefits: Maintain range of motion and strengthen muscles that support the hip.  Pain relief.

Risks: Pain may be intolerable, unrealistic expectations, inadequate engagement

Manual Therapy

Ultrasound, laser therapy massage, mobilisation exercise.

Benefits: Helps improve range of motion and reduce muscle tension, may help reduce likelihood of recurrence of symptoms.  Reduction in pain.  Pre-operative preparation.

Risks: May have increased tenderness after hands-on treatment for 24-48 hours, improvement may take a few sessions (1 in 2).  Small risk of nerve compression causing temporary tingling and numbness (1 in 100).  Very low risk of long-term nerve damage.

Corticosteroid injection

Useful for short-term relief of pain but unlikely to affect long-term outcome.

Benefits: Pain reduction

Risks: infection, tendon rupture, hyperglycaemia in people with diabetes, local tissue atrophy, flushing, menstrual disorders in women

Autologous blood injection

Benefits: more effective than corticosteroid for long-term relief.  One study showed 90% participants pain free at six months.

Analgesia

Aim: to control pain and help the person keep active

Medication Benefits Risks Additional Information
Paracetamol No gastrointestinal toxicity, well-tolerated   More effective taken regularly, rather than as required
NSAIDs – Ibuprofen

(naproxen, diclofenac)

Anti-inflammatory Dyspepsia

Gastrointestinal bleeding

Cardiovascular and renal adverse effects

Exacerbate asthma

Not effective for neuropathic pain

Gastroprotection may be required

 

Topical NSAID May be of benefit    

Surgery

Symptoms having substantial impact on quality of life and non-responsive to non-surgical treatment – pain when using the joint or at night, stiffness or reduced function

Hip procedures: Total joint replacement, hip resurfacing, arthroscopy (labral tears), osteotomy, excision of inflamed bursae.

Benefits: Greater mobility and better quality of life, benefits apparent immediately after surgery.  85% of hip replacements still work well 20 years after they are inserted.

Risks: Initial pain from surgery

About 1 in 8 total hip replacements require revision within 10 years: 60% because of wear-related complications.  80% get a good result.

UTI or retention, thromboembolism (Death 1 in 3000), chest infection, implant fracture, dislocation of the hip (~4%), wound infection or dehiscence, infection of prosthesis (1%), bony ankylosis, mechanical loosening (3% at 11 years), foreign body reaction, fracture of femur, nerve (1%) or blood vessel (0.1%) damage.

References

NICE Clinical Knowledge Summaries, available at: http://cks.nice.org.uk/

www.patient.info

Hull and East Yorkshire Hospitals patient leaflets https://www.hey.nhs.uk/patients-and-visitors/patient-leaflets/

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