A third of presentations to primary care are musculoskeletal, and within these hip and spine complaints are common. Hip and spinal pathologies share some common symptoms and may even co-exist. Aim: To identify the proportion of patients seen in a specialist hip clinic whose pathology is spinal & to assess the correlation between symptoms and pathology that present to the clinic, with the aim of improving referral pathways to specialist services. Methods: Electronic patient records were accessed for new patients to the Hip clinic at the GRI for 6 consecutive months. 227 patient records were investigated, and 169 of these were included for analysis.
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Total patients seen between 24/02/16 and 10/08/16: 227 169 met inclusion criteria Those excluded Non-native hips 1 x pregnant woman (no investigations etc , did not present again). Re-referrals – these patients had an established diagnosis of OA prior to attendance in this clinic Patients for whom pain did NOT form part of the symptoms at all – in referral or in assessment. Eg, indentation of skin on thigh) No letter on file in online system (admin failure) 3 patients were deceased on time of file access, but they were not excluded because nobody died prior to diagnosis/management plan. Average follow up period: from 05/06/2017 (date of analysis). Earliest patients 24/02/16 - 467 days, latest 08/08/2016 - 301 days. Average 384 days. Coding notes: Sites: “Leg other” includes posterior thigh, radiating or mobile pain, Knee pain and any pain below knees Ortho Hx: “ORIF NOF” includes CanScrews and DHS – ipsilateral always – still native hip. “soft tissue” includes gluteal tendinopathy, impingement, groin strains, infections etc. “InflammArthr” includes RA, AnkSpond, JIA, Psoriatic arthritis “Trauma” includes recent falls, as well as historic trauma eg previous pelvic fracture and “accident at work”. “Abnormal Anatomy” eg hypoplastic leg, leg length discrepancy, pelvic distortions from previous trauma. Management: Referrals were made to other orthopaedic specialists (eg CAM lesions/impingements), Hand ortho, Pain clinic and to Spinal surgeons. OtherOrthoOps: excisions eg of metalwork or heterotopic ossification. “conservative” includes watch and wait (patient not willing to have surgery for example), Gp led medical management, exercise advise/weight loss and certain medical treatments (eg analgesia). Referred by Other med: Neurology (1), Rehab (1) Other surg: Urology (1), GenSurg (1), Ortho(3 – eg knee). 3 patients referred with BILATERAL hip pain, but always focused on unilateral (worse side) when in clinic. Diagnoses: OtherSpinal Path: Disc protrusion, Nerve root compression/irritation, Spinal Stenosis/ severe degenerative changes).