NHS hip assessment phone call, what to expect (hip replacement qs too)

[UncertainWife]

I've got osteoarthritis in my hip/s, I've been referred to MSK for a telephone assessment.

It's a 40-minute phone call, anyone know what kind of things they'd ask me to do to assess the hip? For me the pain mostly comes after walking or trying to do jobs around my house, or when trying to get to sleep, so I can't imagine what they'd ask me to do on a phone call when I'm in my house that would demonstrate the problem.

My hip OA has changed how I walk, it's made me lopsided, and walking feels so horrible and weird and is causing me problems in other body parts as well. I'm limping a little and hobbling.

I'm concerned that because it isn't immediate agony when I eg lift up that leg that they won't refer me for a hip replacement, when I feel I need one.

I've already tried physio and it didn't work, and I don't want the injections, but GP told me you had to have had physio and injections before you can get the replacement, is that correct?

Google “Oxford hip score”, those were the questions I was asked. They won’t ask you to demonstrate, but you need to tell them all the ways it affects your life.

I’ve had both hips replaced, I had to do physio for each (it helped one but not the other) but I wasn’t even offered injections as the consultant said it wouldn’t be helpful.

Thanks, I'll google that. Great that you saw a consultant, I don't think you can do that any more in NHS until you've done physio then had injections. That was what my GP said, and I specifically moved to this GP because a few years ago she told my dad's friend 'physio and injections don't work, let's get you referred to a consultant for a replacement'. If same GP is now saying I must have injections then the rules must have changed, I assume.

Were your hip ops posterior or anterior and are you happy you had them done?

To be fair, I had the injections and they gained me about 4 years of pain free movement, but they are odd in that they work for some people some of the time and not others - it's all a bit "weird". As I said, the first time I gained 4 years of pain free movement; the second lot didn't work at all and I had to have a replacement. Given how long it is likely to be before you get an NHS replacement (what they say and what actually happens being very different) if it is an option I would think twice before refusing it. You have nothing to lose and everything to gain.

I don't know what the waiting time is where you are, but my friend has been waiting 18 months and had it cancelled last month due to the hospitals being full of flu cases. And it is very unlikely that they will even place you on a list until (a) you have had physio and proper physio assessment and (b) you have been seen by a consultant. It isn't a case of you feel you need it - if you haven't yet had your first MSK appointment are you actually even sure that you have osteoarthritis - you actually need a physical test (like an MRI, X ray or CT scan) to confirm that.

I know it sounds daft, but it is just possible that you are wrong without a confirmation test because there are so many types of arthritis and other things that it might be that it's tough to diagnose by exclusion (which is what GP's tend to do). I do have osteoarthritis, and it was in both hips (and elsewhere) but when they did the CT scan they found that the osteo in my right hip is far far worse and advanced than it was in my left hip. I have never had any pain in the right hip! But the "better" left hip had to be replaced.

I would also suggest that you make a list of question that you want to ask - you'll forget everything on the day. And have a pen and paper handy to make notes of anything that comes up that you want to ask questions about, because again you can easily forget to come back to something.

One last thing that occurs to me - again about proper testing being necessary - another friend was diagnosed with OA in her hip by her GP and MSK. She didn't have it! Her problem was in her pelvis and wasn't arthritis at all. She had six months of physio and was fully recovered after that. I mention that because like you the problem caused difficulty walking, pain in the hips etc.

I hope that helps - obviously it's all personal experience and that varies from one person to another.

I've had several x-rays over the years, I was first diagnosed with OA about 3-4 years ago and it's deteriorated gradually since then (at first it was mild, last x-ray it was moderate with bone spurs and my guess is that it'd be worse now as the pain has worsened since last x-ray). I've been referred for physio, tried it, it just aggravated the pain and meant I couldn't sleep so I stopped it.

I've had many years of being unable to walk long distances. Just over a year ago I had to give up the gym because I couldn't do the classes any more, but because I could still sleep and still walk around up to one hour I just put up with it.

Since September it's all deteriorated and I now get back pain too, I can't do housework, can't walk longer than 10-15 mins. My whole life is pretty much on hold. So I'm happy my new GP referred me on to MSK for this assessment.

Thanks again @SoManyTshirts for the mention of the Oxford score for hips, I score 16, which falls into the 'refer for surgery' category. I'm so relieved! And also scared. I don't actively want to have surgery, I just want my life back.

Thanks for mentioning the waiting times (and cancellation) @EmmaMaria that's v helpful as I'm also considering getting a loan and going private (though would first see what NHS situation is)

Can't believe in 2025 we are still having telephone consultation for hip problems. What's wrong with old fashioned seeing the patient and examining them?!

@UncertainWife there is (or at least there used to be) a middle ground between the NHS and private. You can have an initial private consultation, which gets you to see a consultant without having to go through the 'wait for physio - have physio - wait for pre consultant assessment - wait for consultant appointment' hoops. If the consultant decides you need further investigations you can have those on the NHS, though you'll still have the normal waiting times. If he decides you need surgery he can put you straight on to either his private list or his NHS list. If you choose the NHS list you'll still go in the queue but at least you won't have to go through all the preliminary waiting times. He will have a good idea of what his waiting time currently is and hip replacements are often fixed price, so you'll be able to decide on whether it's worth it to you to pay £x to avoid a wait of a further n weeks.

Thanks @MontyDonsBlueScarf I've been considering this option. But thought I may as well go to the NHS appointment first as it's this week, just in case they refer me to a consultant to discuss the op.

If they only want to refer me for injections I'll set up a private appointment with a consultant.

Have you had a CT or MRI? Although they can see the damage in an xray they need another scan to look into it further. How old are you?

The wait is years on the nhs. I could barely weight bare by the time I had my second done. Don't let them fob you off.

I was 27 when I had my first. 31 when I had my first knee, 32 for my second hip and then 33 for my second knee! So don't let them tell you age is a big deal.

Mine was RA which resulted in OA

A friend of mine has been waiting for a hip replacement for years. He's in constant agony and hobbles short distances with a stick. He's been told that they won't do anything until he literally can't walk at all any more. He is now over 80 and he said to me that he thinks they are waiting for him to die so they won't have to bother giving him a hip replacement at all.

So my advice would be to lay it on thick and tell them how bad it is already.

@UncertainWife Going to be honest - mine was done within weeks but I have private cover. And the only reason it took that long was because I had complications which meant that I needed to go to a specific hospital (perversely the private wing of an NHS hospital with a consultant who also worked at the NHS side). Mine was complicated by the fact that the arthritis caused my hip bone to crumble and break up (who knew that could happen - I didn't) and I happened to have a broken ankle at the same time on the other side!!!! If you really are that bad (nor suggesting you aren't, just saying it's a lot of money) and you can afford it, I would definitely go private in your shoes.

To be fair my one MSK appointment was pre-Covid and the only reason why a telephone appointment wasn't done was because they couldn't do them then! The assessment involved not a shred of physical examination - just a chat. It was really a waste of my time travelling there and back and sitting in a waiting room. Unless things have changed I'd prefer telephone ones.

I have recently been through this and I do think there is checklist they go through before they refer you to the next stage. It wasn’t explicitly said though. It went physio, injections, Consultant, MRI (plus additional Cat scan and X-rays) - I got referred for a second opinion because of my age and then surgery.

In total I have had issues for about four years. But from OA diagnosis to going through the steps to double hip replacement has been about 18 months. But I went privately and think if I had them done on the NHS I would still be waiting for my first.

My hip scars are on the side of my leg, rather than anterior/ posterior.
For the first one in 2022 I was very incapacitated but was told I’d be waiting years (I was early 60s) so paid private.

Second one this year I didn’t think I’d attain the necessary hip score but my normally very active life was definitely impacted, and I had a new hip on the NHS after a short wait. Same private subcontractor, same surgeon.

I’d recommend it to anyone. I was fully recovered within weeks and had very little post-op pain.

No CT or MRI. At what point in the process would someone refer me for one of those? I'm early 50s.

@slightlydistrac I feel so sorry for your friend, that's dreadful! He should be able to get one if he's hobbling around.
@EmmaMaria that's great that you had private cover. I can't really afford private, but could get a couple of credit cards or a loan, but will wait to see NHS situation first. And I agree, I'm happy with a phone consultation if it's just going to be a chat. Moving around is difficult for me!
Interesting reading your experiences @Sweetbeansandmochi and @SoManyTshirts thanks for posting.

Only if they're not sure from the xrays, history amd examination.

The vast, vast majority of patients having a hip replacement dont need a CT/MRI.

Thanks for explaining @FixTheBone

Just to clarify for the OP though, it is true and you don't absolutely need a CT /MRI IF they are also absolutely sure that no part of the problem lies elsewhere. You can have arthritis in the hip and elsewhere and both contribute to the problem, or elsewhere and not in the hip but feel it in the hip. Good diagnosis needs clarity, so they may want to do this to be sure of the total problem - I know that physiotherapists find this useful when planning exercise regimes. Xrays, history and examination may not show all the issues up, and given the OP has expressed a series of complex symptoms linked to mobility, in her shoes I might want to ask for one. In all honesty, from what I understand, this is one of the few things there isn't much of a waiting list for! The OP has said that the arthrtis in her hip is causing problems in other parts of her body, pain and "weird" gait etc. Those may not be a result of something in the hip.

I can provide a practical (and when you think about it, obvious) example. If I stand or walk for more than a few minutes my right foot goes numb. I can't feel it. I feel nothing at all including my foot on the ground, so I can (and this sounds stupid, I know) actually "miss" the ground. My brain thinks my foot is on the ground but it isn't. It might be an inch only above it but that one inch can make me crash down on the foot and lose my balance. (a) That is actually pain! It doesn't feel "painful" but in medical terms it is how my brain is processing "pain" and (b) the actual problem is arthritis in my spine - nothing to do with the foot or the hip. Without the MRI they wouldn't know what is causing that because it isn't visible to the human eye or to examination

I've just had the MRI results back for my lower back, they found a bulging disc at L4 & L5 pressing on the nerves.

I've just started a new post in AIBU (for traffic) asking if I can improve my back with physio while I have the hip problem. A back exercise specialist I saw said the hip problem was causing the back problem, and various people on hip replacement forums have talked about back pain that was improved by hip replacement. One even mentioned having back surgery and rods etc, but that didn't fix the back pain, the hip replacement did!

Do any of you have any knowledge or experience of a bulging disc alongside hip arthritis?

I'm leaning towards going to see a private consultant to discuss hip replacement, but obviously don't want to panic buy a new hip in the hope it'll fix my back if it's the wrong thing to do (though hopefully the consultant wouldn't let me have THR if I wasn't in need of it).

I'm pretty miserable with a huge decrease of quality of life these last few months - I just want my life back, but it's hard to know who to listen to. GP on the phone just now said physio for the whole lot, but as I'm getting worse daily with activity I can't see how that would magically fix me.

If you are going to think about spending a lot of money - I would suggest you spend a little now and get a few physio appointments. Because yes, you can improve your back (and possibly even the hip a little) even if you really do need a hip replacement. It might help - it might even buy you time for the NHS waiting list and save a lot of debt for you. It won't fix you and it won't do it overnight, but it really can help.

I have physio and have had for a few years now. When I first went - a few years after the hip replacement I had low expectations. And I will never be able to walk well or far - that is a given based on the amount of stuff wrong with me. But my proudest moment was walking the whole of the Malecon in Puerto Vallarta in both directions. Two kilometers. OK that was with a rollator, it took me hours and I had to stop frequently (luckily there are loads of shops and cafes!). But the fact is that I did it, when I couldn't have done before.

If I am guessing right, you will never "get your life back" but you can learn to compromise - get someof the old life back and adapt for the rest. I used to travel the world, loads of hiking etc. I've walked in the Himalayas, the Andes, even the Sahara. I will not be doing that again any time. My two kilometers on the Malecon was just as big a challenge though, a different sort of fun, and there are no whales to watch in the Andes. You can remake your life, but a hip replacement is not going to do that on it's own. You need to grit your teeth and suck it up - your hip is only one bit of you, and you can't let the rest go to waste.

The other think to check out is that in some areas GP's and physio's can "prescribe" exercise - either free or at very reduced rates. I have a pass to my local swimming pool and gym as a result, and there are professional trainers there who can advise on appropriate exercise.

Well done on that two km on the Malecon @EmmaMaria - great job.

I left out a part of my thoughts/plans in my previous post. I know I definitely need to do physio and exercise to improve my back disc issue.

But my worry is that I can't do anything useful or helpful exercise-wise while I have the hip issue because it's tilting my whole body to the right (bad hip side) - the joint space has narrowed and made the bad hip leg shorter. I can almost visualise how this would put pressure on my spine, because my gait is off.

So walking is usually good for a bulging disc in the back, and also for arthritis, but the way it feels to me now is that with the hip all wrong, I'm walking myself into a worse problem with my spine.

It feels like I need to get the hip fixed, so I can do the hard work on my back from a place of alignment.

BUT it's so easy to convince yourself of something that may be wrong!

ps it doesn't help that whenever I've seen physios everything they give me to do makes the problem hurt more.

Sometimes you have to work through the hurt! Provided it's not intolerable of course. And back strength can be improved without walking - as in swimming, water based exercise, etc. The longer you wait, the more the problem becomes ingrained. See a physio - tell them what the problem is, what your concerns are and discuss it. It's a two way process - they need to hear from you too. It did just occur to me - not sure about this but my friend got referred by her GP to something called a pain management clinic, it was very fast and she got monthly NHS physio which she said was very good. I don't know if that happens everwhere but if cost is an issue it might be worth asking.

Thank you that's a good point about water-based exercise. There's a salt pool in my area where they give you a guided session with exercises recommended by a physio so I could at least try that.

I feel so depressed and panicky today, before I got my MRI results I'd convinced myself that the issue was all in my hip and now I feel I'm staring down the barrel of becoming disabled because I have two problems and I can't envisage recovering from either of them.

In August I was walking around on holiday, being normal (ish, I still had the hip arthritis and some generalised upper body pains). Now I can't even get round my local park for 10 minutes walk.