About
Dr. Sohrab Gollogly MD, is a board certified fellowship trained Orthopedic Surgeon in private practice in Monterey, California. He provides consulting services online, as part of his practice. He will review X-rays and medical records for patients who contact him through this website.
Dr. Gollogly is on staff at Community Hospital of the Monterey Peninsula (www.chomp.org) and he is also a member of the Monterey Peninsula Surgery Center (www.montereysurgerycenter.com). His practice, CHOMP, and MPSC all accept the majority of insurances in the State of California and CHOMP recently became a member of the CALPERS joint replacement network.
His practice emphasizes direct anterior total hip arthroplasty and surgery of the spine and he has performed all of the procedures described in this site and all of these clinical examples and X-rays are of his patients. His clinic is in Monterey, California.
Why Hip and Spine?
My surgical practice emphasizes surgery of the spine and hip. About 50% of my clinical practice is devoted to the management of arthritis of the hip and 50% is devoted to management of spinal disease. I have chosen to stay active in both areas because the most common reason that a patient comes to see me is illustrated in this picture of the “C sign”.
The “C sign” is demonstrated by a patient who indicates “I have pain here”, touching the groin with the thumb and the buttocks and side of the hip with rest of the hand. The first question I ask is why does the patient have pain, and what anatomic structure is causing the pain? The list of possible causes is evenly split between the spine and the hip. They could have degenerative disease of the lumbar spine or a disk herniation with a pinched lower lumbar nerve root and those are both spinal diseases. They could also have trochanteric bursitis or osteoarthritis of the hip joint itself, and those are both hip problems. Often, the patient may have disease affecting both the hip and spine — so called hip spine syndrome. In an excellent review of this complex of symptoms published in the journal spine, the authors noted that “significant lumbar spinal stenosis and lower extremity arthritis may coexist and this may lead to diagnostic uncertainty.” I have a saying in my practice that “accurate treatment begins with an accurate diagnosis” and in my experience I have had a number of patients referred to me with an abnormal MRI scan of the spine who turned out to have symptomatic osteoarthritis of the hip, and vice versa.
Here is a typical example of someone who has disease in both areas. This is a 50 year old woman who is very active, who is bothered by low back pain and left hip pain. She complains of a limp, less walking endurance than she used to have, pain centered over the greater trochanter, with radiation of the pain down the side of the thigh, occasionally below the knee. When asked where the pain is most frequently located, she demonstrates a classic “C sign”.
An MRI scan was obtained by her primary care doctor and she was referred to my office for a consultation for spinal disease. Here is the MRI scan of her lumbar spine which demonstrates a spondylolisthesis at L4/5 as seen on the sagittal on the left and the axial view of the spine on the right.
Here are the xrays of her left hip which demonstrate a bone spur developing at the edge of the acetabulum (outlined in black dots in the second image)…
…and her MRI scan which demonstrates moderate femoral acetabular impingement and a degenerative tear of the labrum.
In her case, an intra-articular injection of anesthetic which was performed as part of the MRI arthrogram completely relieved her pain and she was able to walk without a limp. Since her symptoms were eliminated by the injection, we chose to focus on the hip first. She underwent an arthroscopic labral debridement and at the time of surgery it was apparent that the arthritis of the hip was more extensive than the MRI scan or the plain xrays revealed. In the following two pictures we see an image of the arthroscopic shaver being used to clean up the torn and frayed labrum in the hip joint and in the second procedure, the tip of the bent probe is pointing at the area of exposed bone where the cartilage has delaminated from the acetabulum
As a result of this diagnostic workup and treatment she was #1 — able to avoid spine surgery, #2 convinced through the process of the intra-articular injection that her hip was the cause of the treatment, and #3 achieve pain relief through a hip arthroscopy. While she is likely to need a hip replacement as her arthritis progresses, it is comforting for the patient to know that her diagnosis and treatment plan is an accurate one.
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References:
Hip spine syndrome: management of coexisting radiculopathy and arthritis of the lower extremity. Spine J. 2003 May-Jun;3(3):238-41, Fogel GR, Esses SI.
CONCLUSIONS: Evaluation of the patient with lower extremity pain in consideration for total joint arthroplasty should include functional inquiry of the spinal nerves. Diagnostic tests and injections may allow an informative weighting of the patient’s symptoms, leading to a better understanding of the patient’s pain syndrome. There is a group of patients who have a total hip arthroplasty and then develop or may continue to have pain of groin and buttock, secondary to sciatica of lumbar spinal stenosis. For the patient undergoing total hip arthroplasty with asymptomatic spinal stenosis, there may be increased neurological risk at surgery, related to the stenosis. The patient with both conditions may require surgical decompression of the lumbar stenosis as well as joint arthroplasty of the arthritic joint.
