The Hip Center

Our prestigious Hip Program is led by Board Certified Orthopedic Surgeon Dr. Richard McCormack.

Hip Conditions & Procedures

Performed at The Hip Center at Total Orthopedics

Hip Conditions We Treat

At Total Orthopedics & Sports Medicine, we treat a variety of conditions involving problems with the Hip. Select a condition below to learn more.

Hip impingement (Femoral Acetabular Impingement)

Femoral Acetabular Impingement Syndrome (FAI) is a condition that occurs as a result of the bones of the hip being misshaped.  Due to this misshaping, the bones of the hip do not fit together as intended and causing unnatural friction of the bones and joints.  Over time, this friction causes degeneration of the cartilage, bone spurs and damage to the joints.

There are three types of FAI: pincer, cam, and combined impingement.

Pincer

This type of impingement occurs because extra bone or bone spurs protrudes over the rim of the acetabulum (the cup shaped cavity of the hip bone where the femur sits). The labrum becomes compressed under the extending rim of the acetabulum.

Cam

Cam impingement occurs when the head of the femur is not rounded and cannot rotate smoothly inside the acetabulum. Because of this, a protrusion forms on the head of the femur and degenerates the cartilage inside the acetabulum.

Combined

Combined impingement means that both the pincer and cam types are present.

Signs and symptoms of FAI can include:

  • Pain in the groin
  • Pain at the outside of the hip
  • Limited range of motion
  • Pain when turning or twisting
  • Dull ache in the hip
Labral Tears

The labrum of the hip is the cartilage that surrounds the ball and socket joint of the hip and helps provide lubrication so the joint can function properly.  The labrum also acts as a shock absorber preventing damage to the joint.   Athletes who engage in contact sports or those that require long episodes of running are at heightened risk of Hip Labral Tears.

Labral Tears of the Hip generally occur in two forms: degenerative tears and traumatic tears.

Degenerative Labral Tears

Degenerative Labral Tears occur over time as a result of wear and tear.  Microtraumas cause small tears in the cartilage the begin to weaken the labrum.  Eventually, these tears compromise the integrity of the labrum until the labrum tears.  This is most often seen in athletes or those who are in the early stages of arthritis of the hip.

Traumatic Labral Tears

Traumatic Labral Tears occur as a result of a sudden impact or injury to the labrum.  Sudden impacts or injuries can be a result of falls, sports injuries or an unnatural and forceful motion of the hip.

Signs and Symptoms of Hip Labral Tears can include:

  • Hip pain
  • Groin pain
  • A “clicking” or “popping” sound in the hip
  • Limited range of motion in the hip
  • Pain that intensifies during or after activity
Snapping Hip

Snapping hip is a condition where the patient will feel or hear a “popping” or “snapping sound” when they stand, walk or swing the leg. Snapping Hip can occur in the front or back of the hip depending on which muscle or tendon is affected. The condition is a result of the muscle or tendon of the hip shifting over the bone of the hip. While in most instances the condition is painless, it can lead to irritation and inflammation of the bursa, known as bursitis.

In some cases, the snapping is a result of damage to the cartilage of the hip, specifically the labrum. Damaged cartilage can become loosened or dislodged and float into the hip joint causing a feeling or snapping or locking. This form of Snapping Hip is usually accompanied by significant pain and may become disabling.

Symptoms may include:

  • Hearing a popping or snapping sound when standing or walking
  • Feeling of locking or catching of the hip joint when standing or walking
  • Pain in the front or rear of hip when standing or walking
Trochanteric Bursitis

Trochanteric Bursitis is an inflammation of the bursa (a fluid filled sack near the joint) on the outer side of the hip.  This condition is the most common cause of hip pain and may cause difficulty doing daily activities such as walking and sitting.

Trochanteric bursitis can have many causes including a traumatic incident, such as a slip and fall or sudden impact to the hip.  However, chronic overuse, improper posture and sports injuries can result in symptoms as well.

Rheumatoid arthritis, gout, psoriasis and thyroid disease can also bring about this condition. In rare cases, bursitis is the result of an unrelated infection.

Signs and Symptoms of Trochanteric Bursitis can include:

  • Pain in the hip, thigh or buttock
  • Pain when lying on affected side of hip
  • Sensitivity to touch
  • Increased pain when going from seated to standing position
  • Increased pain after periods of activity
  • Pain when walking or climbing stairs
Piriformis Syndrome

Piriformas Syndrome is a condition in which the piriformis muscle of the hip begins to compress the sciatic nerve in the lumbar spine. The piriformis is a long band-like muscle located in the buttock and near the top of the hip. This muscle allows the body to turn and pivot when running or walking and is especially strong in athletes.

The sciatic nerve is the longest continuous nerve in the body and extends from the lumbar spine down into the legs.

Piriformis Syndrome occurs when the piriformis muscle spasms and irritates the sciatic nerve, which is located directly beneath it.

Symptoms may include:

  • A dull ache in the buttock
  • Pain radiating down the thigh and into the leg
  • Pain when walking up a flight of stairs
  • Reduced range of motion in the hip
Proximal Hamstring Tears

The hamstrings are a grouping of four muscles located on the back of the thigh and allow for the extension of the hip and knee. When one of these muscles becomes detached from the hip, it is known as a complete hamstring tear.

Most often, this is a result of an overexertion of stress on the muscle and is especially common among athletes. However, hamstring tears can also be the result of poor conditioning, muscle fatigue or muscular imbalance.

Symptoms may include:

  • Sudden swelling of the hip
  • Bruising or discoloration at the back of the leg and around the knee
  • Persistent weakness of the knee or hip
  • Persistent pain in the thigh or hip
Osteoarthritis of the Hip

Osteoarthritis is the most common form of arthritis in the hip and is also known as “degenerative joint disease”.  Osteoarthritis occurs when the cartilage covering the bones and joints of the hip begins to break down causing pain and inflammation in the hip.   Several factors can contribute to the likelihood of Hip Osteoarthritis including, genetic predispositions, unhealed fractures and weight.  There is no single test for Hip Osteoarthritis.   Diagnosis may include an evaluation of medical history as well as a physical exam. Depending upon the severity of the symptoms, X-rays and/or blood test may be needed to confirm Hip Osteoarthritis.

An important thing to note is that symptoms tend to appear in “flare ups”.  This means that those with this condition may not have constant symptoms and may note “good weeks and bad weeks”.  However, despite the ebb and flow of Hip Osteoarthritis, the condition may still be progressing.

Signs and Symptoms of Hip Osteoarthritis may include:

  • Hip pain
  • Change in gait and stride
  • Limited range of motion
  • Joint pain or swelling
  • Pain during or after activity
  • The feeling of bones “rubbing” together
Avascular Necrosis of the Hip

Avascular Necrosis (AVN) of the hip is a condition where the bone of the hip begins to degenerate due to decreased blood flow to the bone. When blood flow to the bone is stopped, the bone will deteriorate and become unstable and may eventually fracture. The common area for AVN in the hip is the ball shaped joint of the hip known as the femoral head.

AVN is commonly a result of an underlying health condition including:

Dislocation of the Femur:

A previous dislocation of the femur can cause interrupted blood supply to the bone and can increase the risk of AVN.

Corticosteroid Use:

Corticosteroids are commonly used as a way to decrease inflammation in the joints. However, prolonged use of these substances has been linked to increased risk of AVN. Although the reason is not completely understood, orthopedic specialists suspect that these drugs may interfere with the body’s ability to break down certain substances and these substances can build up in the blood vessels and cause them to become constricted.

Excessive Drinking of Alcohol:

Alcohol has also been linked to the build up of fatty substances in the blood vessels and causing them to become constricted.

Hip Procedures

At Total Orthopedics & Sports Medicine, we treat a variety of conditions involving problems with the Hip. Select a procedure below to learn more.

Total Hip Replacement

Total Hip Replacement has become a viable option for those who have significant degeneration or arthritis in the hip.   Advancements in surgical approach, technology and implant materials has now allowed patients to return to an active and healthy lifestyle after Hip Replacement Surgery.

Total Hip Replacement removes the damaged bone and cartilage of the hip and replaces them with prosthetic materials.

 During this procedure, the damaged femoral head is removed and replaced with a metal stem that is placed into the center of the femoral stem is cemented or pressed into the bone.

Next, a metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed. The damaged cartilage surface of the socket is then removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.   Last, a ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

The removal of the degenerated bone and the implant of the artificial ball and socket joint allows for the natural anatomical motion of the hip to be restored. The durable implants serve exactly as the degenerated bones once did.

Total Orthopedics and Sports Medicine surgeons utilize an arthroscopic approach for this procedure to ensure accuracy and efficacy.  This less invasive approach allows patients to return to activities and daily routines much more quickly than with traditional surgery.

Ultrasound Guide Injections

Injections of the Hip are an effective non-surgical treatment for those experiencing chronic hip pain as a result of arthritis or injury to the hip.  This injection is a needle-based procedure and requires no incision.  In most instances, only a local anesthetic is needed.

To begin this procedure, the physician will anesthetize the area and administer a local anesthetic.  Next, a contrast dye is injected into affected area.  This contrast dye allows the physician to ensure proper placement of the needle as the dye is visible using fluoroscopic (real time x-ray) guidance.

Next, a mixture of anesthetic, saline and anti-inflammatory medicine is injected around the painful joint under fluoroscopic guidance.  This mixture helps reduce the inflammation of the joint that is causing the pain.  The needle is removed and a small bandage is placed over the injection site.

Hip Injections are often an effective alternative for those looking to avoid surgery.  This procedure is performed under fluoroscopic and X-ray guidance to ensure accuracy and efficacy.

There are several different types of injections including iliopsoas tendon injections, greater trochanteric bursae injections and piriformis injections.

Hip Arthroscopy

Hip Arthroscopy is one of the more common procedures for a variety of hip conditions.  This procedure uses one or more small incisions and small endoscopic cameras to allow surgeons to view damage to the hip joints, bones or cartilage in high definition.  Once the camera has been inserted, the surgeon uses microsurgical tools to remove damaged tissue or debris that is causing hip pain.

To begin this procedure, the surgeon will make one or more small incision around the damaged area where the pencil sized cameras and surgical instruments will be inserted.  Next, a clear sterile fluid is injected that allows the surgeon to visualize the area in greater detail.

Once the surgeon has visualized and evaluated the area, the surgeon may decide tissue or ligaments need to be trimmed or partially removed.  Small surgical instruments are inserted to remove the painful tissue or ligaments.  The incisions are closed with small stitch or sterile strips.

Total Orthopedics and Sports Medicine surgeons utilize an arthroscopic approach for this procedure to ensure accuracy and efficacy.  This less invasive approach allows patients to return to activities and daily routines much more quickly than with traditional surgery.

Labral Repair of the Hip

Hip Labral Repair is an effective arthroscopic surgical treatment for those experiencing chronic pain in the hip as a result of a torn labrum of the hip.  This procedure uses one or more small incisions and small endoscopic cameras to allow surgeons to view damage to the hip joints in high definition.  Once the camera has been inserted, the surgeon uses microsurgical tools to remove damaged tissue or debris that is causing hip pain.

To begin this procedure, the surgeon will make one or more small incision around the labrum where the pencil sized cameras and surgical instruments will be inserted.  Next, a clear sterile fluid is injected that allows the surgeon to visualize the area in greater detail.

Once the surgeon has visualized and evaluated the area, the surgeon may decide the tissue surrounding the labrum may need to be trimmed or partially removed.  Small surgical instruments are inserted to remove the painful tissue allowing the hip joints to slide back into their normal position along the labrum.  The incisions are closed with small stitch or sterile strips.

Total Orthopedics and Sports Medicine surgeons utilize an arthroscopic approach for this procedure to ensure accuracy and efficacy.  This less invasive approach allows patients to return to activities and daily routines much more quickly than with traditional surgery.

Resection of Impingment Lesion

Extra bone that can cause pain and limited motion. The extra bone is simply minimized through an arthroscopic procedure. With this procedure, patients can achieve a decrease in hip pain and an improvement in function.

Hip Preservation debridement, removal of loose bodies

The specialists at Total Orthopedics and Sports Medicine utilize a variety of procedures intended to preserve the integrity and function of the hip as well as mitigate arthritic symptoms. These procedures can include:

Arthroscopic Microfracture Hip Surgery:

Hip Microfracture Surgery is often utilized in an effort to restore blood flow to a degenerative bone. The procedure involves the surgeon making 2-4 perforations into the bone in an effort to have the body trigger its natural healing response. This healing response includes the increase of blood flow as well as the body’s natural restorative cells and plasma. Research has shown that this new flood of blood and healing cells can form new healthy cartilage in the affected area.

Debridement and Removal of Loose Bodies:

This arthroscopic procedure is utilized to remove loose fragments of cartilage or bone spurs that may be causing pain or irritation of the hip. During the procedure, the surgeon will use a small camera, known as an arthroscope, to visualize the affected area of the hip. Once the loose bodies have been identified they can be removed and loose cartilage can be trimmed, if needed.

Total Orthopedics and Sports Medicine surgeons utilize an arthroscopic approach for this procedure to ensure accuracy and efficacy.  This less invasive approach allows patients to return to activities and daily routines much more quickly than with traditional surgery.

Proximal Hamstring Repair

Through a small incision in the gluteal crease, the torn hamstring can be repaired back to the bone from which it tore. Patient’s experience improvement in function and decrease in pain after this procedure.

Gluteus Medius Repairs

This procedure involves the surgeon locating the site of the tear in the gluteus medius using a small camera, known as an arthroscope. Once both ends of the muscle are located, the surgeon will align them back into their natural position. Once realigned, small sutures and achors will be used to reattach both ends of the tendon in its proper location on the outside of the hip. These sutures allow for the proper functioning of the muscle as well as reduction in pain.

Over time, the fibers of the muscle will “knit” back to form one continuous muscle that is both strong and flexible.

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