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Hip not x-rayed

01 November 2004

When Mr R, a 22-year-old man, told Dr A that he had been suffering from a pain in his left hip for the past three months, the GP suspected a muscle strain and prescribed anti-inflammatories.

According to his notes, Mr R’s hip was ‘tender’ and external rotation was painful, but all other movements were painless, although Mr R also said that he was unable to walk due to the pain.

He saw Mr R five weeks later, who again complained of pain in his hip. A further prescription of naproxen was given. Four months then passed before the next consultation. The notes record that external rotation was still painful.

Ibuprofen was prescribed, and Mr R advised to return two weeks later. This he did, and upon finding that the hip pain was still present, Dr A referred him to a rheumatologist and arranged for x-ray and blood tests to be carried out.

The x-rays revealed a destructive lesion in the inferior margin of the femoral neck. A biopsy confirmed this as an aneurysmal bone cyst. Due to the extent of the lesion, a total hip replacement had to be performed.

An action was brought against Dr A. It was claimed that, given a history of hip pain and restriction of movement over a period of four months, he had failed to arrange further investigations, including an x-ray.

Expert opinion

In the opinion of an expert we consulted on this case, the standard of care provided by Dr A would be difficult to defend. Referring to the first consultation between Dr A and Mr R, he said:

‘The claimant was a very healthy young man with no history of arthritis… had he attended with a three day or even three week history of a painful hip with minimal signs on clinical examination, I believe that it would have been reasonable to have treated him with an anti-inflammatory drug.

‘However, despite the minimal finding of pain on external rotation, I do feel his hip should have been x-rayed at that time, particularly as he gave a three month history (of hip pain) and also complained of not being able to walk on the hip because of pain.’

The case was settled before reaching trial.