Total Joint Center Medical Services

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Total Joint Center


For Hip Pain


Our Diagnostic Services
It is important to get an accurate diagnosis of the cause of your hip pain so that you can receive the correct treatment. At the Total Joint Center, we specialize in evaluating and diagnosing hip problems. As part of your evaluation and diagnosis, the doctor will review your history.  The doctor will ask why are you coming to see the doctor or when and how did your hip pain start? In addition, the doctor will perform a physical exam. To perform the physical exam the doctor needs to move your hip through its range of motion and test the strength of your muscles. As a result of the exam the doctor may ask you to have an x-ray, an MRI (Magnetic Resonance Imaging), an arthrogram or an aspiration arthrogram, or a gadolinium scan. These tests will help the doctor make a differential diagnosis. (If you already have x-rays, please bring them with you.)



Procedures for Hip Replacement
The Total Joint Center is dedicated to the care and treatment of hip pain. Our orthopedic surgeons offer many effective treatment modalities and always utilize the least invasive measures to treat your pain.

Hip Replacement

Hip replacement surgery has improved markedly over the last 20 years due to improvements in design and materials. 99.9% of the hip replacements performed at the Total Joint Center are performed without cement (non-cemented).

  • Anterior Approach: The anterior approach to hip replacement requires that during surgery, the hip is dislocated to the front. This causes weakness in the front of the hip after surgery. Hip precautions for the anterior approach include: no hip extension, no external rotation of the hip, no crossing your legs.
  • Posterior Approach: With the posterior approach the hip is dislocated to the back during surgery. You are weakest in the back of your hip after surgery. You must not bend the hip to chest or chest to hip greater that 90 degrees, internally rotate the hip or cross your legs.
  • Hip Precautions: When our surgeons use “large head” (36mm) joint replacements, hip precautions are short lived. Depending on your surgeon’s protocol, you may have to follow hip precautions for only two to six weeks or not at all
  • Cross-linked polyethylene: Highly Cross-linked polyethylene is a relatively new plastic insert that has a low coefficient of friction. Friction wears away the plastic. This new plastic is anticipated to last 20-40 years.
  • Metal-on-metal hip replacement: Due to advances in technology there is very little wear and very little friction with a metal-on-metal prosthesis. Chrome cobalt ions can be found throughout the body after a metal-on-metal hip replacement. So far these have not been found to have an adverse effect.
  • Ceramic hip replacement: The high performance ceramic hip has a very low coefficient of friction and very little particulate matter is produced. It is very durable and has a low fracture rate. It is anticipated to last 40 years.
  • The MIS (Mini-incision) hip replacement: Minimally invasive surgery (MIS) for hip replacement was first performed in February, 2002. MIS techniques are used with clinically proven implants and can shorten recovery times, reduce length of stay in the hospital and result in much smaller scars, 3-4 inches versus the standard incision of 6-12 inches.
  • The instruments used in MIS have been improved and modified to enable surgeons the ability to properly align and place the implants though a much smaller incision. This smaller incision also helps to minimize blood loss and post-surgery pain. All of the surgeons at the TJC utilize the MIS surgery for hip replacement.

Hip Resurfacing
Hip Resurfacing is a procedure that is intended for use in a younger (65 years and under) patient population, a more physically active group with a history of hip pain. The procedure is bone conserving. The head of the femur is reshaped and resurfaced and capped with a large metal cap. The femoral neck is preserved. In hip resurfacing, both the socket and the ball components are made of chrome cobalt. The size of the components are almost identical to the size of the natural femur. This is much less likely to dislocate than the smaller head of the typical total hip replacement. This means that patients can return to higher levels of activity without worrying about dislocation of the implant.

Many resurfacing patients have been able to return to their normal leisure activities. The resurfacing device should last for many years, but as it is still a new device (1997), it will take some years before the long-term results can be confirmed.

Injections
The hip joint can be injected with a cortisone-like material that acts as a powerful anti-inflammatory. It is most often given along with lidocaine. The cortisone-like material has been found not to cause any destruction to the cartilage. Injections can bring relief for years, months or weeks. If it brings only 2 hours of relief, it is diagnostic and means that your hip problem has progressed to an end-stage of degeneration.

Hip Arthroscopy
Hip arthroscopy is a minimally invasive procedure similar to knee arthroscopy. A small camera lens, inserted in the hip joint through a quarter-inch incision, displays imaging on a television monitor, while surgical instruments are manipulated via a second small incision. The procedure takes less than one hour. Patients go home on crutches, which are usually discarded within a few days. Dr. Sampson developed the lateral approach to hip arthroscopy, specifically to treat labral tears and femoral-acetabular impingement syndrome, which is often undiagnosed with plain x-rays. Prior to the development of this technique, arthroscopy had seldom been used as a diagnostic and therapeutic tool for hip pain, due to the extensive muscular anatomy of the hip joint.

Femero Acetabular Impingement
Femero-Acetabular Impingement is experienced by the patient as groin pain. It may initially be from a sprain but it doesn't get better. It can cause labral tears and arthritis of the hip. Femero-Acetabular Impingement is usually treated with removal of the impinging bone at the femoral head-neck junction. Dr. Thomas Sampson has developed an outpatient arthroscopic approach to its treatment instead of a surgical dislocation, which requires an inpatient stay.

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Saint Francis Memorial Hospital
900 Hyde St
San Francisco, CA 94109
(415) 353-6000