Musculoskeletal diseases are the second most costly group of disorders in
primary care in the Netheriands. Of the musculoskeletal disorders, hip
problems occur most frequently in the aged. Therefore, in the coming decades,
prevalence of hip disorders, of which an important part is attributed to osteoarthritis
of the hip,' is expected to increase due to ageing of the population. The report
'Public Health Status and Forecasts 1997' predicts that by the year 2015 the incidence
of osteoarthritis will have increased 36% compared to the current incidence.'
Besides generating high costs, hip disorders have a major impact on the life of
individuals, not only due to the presence of pain, but also because of tl,e adverse
effects on the mobility and daily activities of the elderly. A recent Dutch study in
the open population aged 55 years and over and living independently revealed that
16.6% of the women and 8.3% of the men reported hip pain.' In the Netherlands,
the general practitioner is the fIrst physician who is consulted and therefore plays an
important role in the management of these disorders. Optimal management, however,
requires accurate diagnosis. The Dutch College of General Practitioners has
published national gnidelines for the diagnosis, treatment and referral of many disorders
in general practice.' For hip disorders, however, no such guidelines are yet
available. International (ICPC) codes for several hip disorders in general practice
have been introduced', but these lack clear guidelines as to what clinical criteria constitute
these conditions. The possibility in the ICPC to code a hip problem as 'unspecifIed'
is eagerly accepted by general practitioners; at least one tlilld of tl,e patients
with hip complaints receives no specifIc diagnosis
