Hip Arthroscopy for Synovial Chondromatosis: Tips and Tricks

Arthroscopic management of recurrent synovial chondromatosis of the hip: a case report

Synovial chondromatosis is a rare condition characterized by the chondral proliferation of synovium forming loose bodies which can lead to pain, swelling, and decreased range of movement of the affected joint.

CASE PRESENTATION

Here the authors report a case of eighteen years lady with recurrent hip synovial chondromatosis who was treated previously with hip arthrotomy and loose bodies removal and now she underwent arthroscopic loose bodies removal with partial synovectomy.

CLINICAL DISCUSSION

In comparison to arthrotomy of the hip, arthroscopic management is a minimally invasive surgery that is associated with decreased postoperative pain, earlier improvement in range of motion, a shorter course of rehabilitation, and overall lower morbidity.

CONCLUSION

Thus, the authors recommend arthroscopic removal of the loose bodies and partial synovectomy for the management of synovial chondromatosis of the hip.

Arthroscopic Synovectomy of the Hip Joint: The Regional Surgical Technique

Synovial disease is a common reason for hip joint dysfunction. Although traditionally treated with open synovectomy, with the popularization and development of arthroscopic techniques, arthroscopic synovectomy has become the main surgical treatment for synovial diseases. Given the long soft tissue channel and learning curve, arthroscopic synovectomy of the hip joint has high surgical requirements for surgeons. However, there is currently no standardized surgical protocol for arthroscopic synovectomy of the hip joint to guide the surgeon to perform hip synovectomy in an orderly manner. During the past 3 years, we have employed a novel technique, wherein we divided the synovium of the hip into seven regions based on the anatomical structure and the operating range of the arthroscopic portals. With the assistance of flexion, extension, and traction of the hip joint, synovectomy was sequentially performed under arthroscopic guidance. This regional surgical technique can be popularized and likely has the potential to become a standardized arthroscopic synovectomy protocol of the hip joint.

Usefulness of MR Arthrography of the Hip with and without leg Traction in Detection of Intra-articular Bodies

RATIONALE AND OBJECTIVE

Although intra-articular bodies are a classic indication for MR arthrography and surgical removal, diagnostic studies are currently sparse. To assess the diagnostic performance of MR arthrography with and without leg traction in detection of intra-articular bodies in the hip joint.

MATERIAL AND METHODS

The institutional hip arthroscopy data base (2009-2016: 631 hips) was retrospectively reviewed. Inclusion criteria were hips with and without intra-articular bodies and direct MR arthrography performed with and without leg traction. Twenty-one hips with intra-articular bodies constituted the "disease-positive" group. Seventy-nine randomly selected hips without intra-articular bodies constituted the "disease-negative" group. Images were reviewed independently for presence of intra-articular bodies by two blinded readers. Overall diagnosis and location of intra-articular bodies was recorded (peripheral or central). Arthroscopy served as goldstandard for diagnosis and location of intra-articular bodies. Diagnostic performance and kappa statistics of traction MR arthrography with and without traction were calculated.

RESULTS

For both readers sensitivity/specificity of traction MR arthrography was 86%-95% respectively 90%-91% for overall diagnosis of intra-articular bodies and was 81%-86% respectively 90%-92%for MR arthrogrpahy without traction. For central intra-articular bodies sensitivity was higher for both readers with traction (79%-89%) than without traction (74% each).

CONCLUSION

MR arthrography with and without traction of the hip is highly accurate in identifying central and peripheral intra-articular bodies. Application of traction was further useful for visualization of centrally located intra-articular bodies.

Simultaneous pigmented villonodular synovitis and synovial chondromatosis of the hip: case report

This report presents a case of a 37-year-old female with a history of hip pain. Magnetic resonance arthrography revealed loose bodies within the joint and synovial hypertrophy indicative of synovial chondromatosis (SC). Hip arthroscopy revealed free chondral bodies and focal villonodular synovial proliferation. The focal synovial proliferation was excised, a total synovectomy performed, and all cartilaginous free bodies removed. A post-operative histological examination of the removed nodular mass and synovium yielded evidence of both SC and pigmented villonodular synovitis (PVNS). A 1-year post-operative clinical examination showed marked clinical improvement and no signs of recurrence on MR images. Despite the clinical similarities, PVNS and SC are two distinct conditions that, to our knowledge, have never been reported as simultaneously occurring in a hip joint. The simultaneous presence of both pathologies may suggest a common origin of synovial metaplasia.

Synovial Chondromatosis: A Rare Differential Diagnosis of Hip Pain in a Child

Introduction:

Primary synovial chondromatosis (SC) is a disease of the synovium occurring in the third to fifth decade of life with the peak incidence in the fifth decade and commonly involves the knee in 50% cases. The diagnosis of SC is primarily radiological and intraoperative. Primary SC of the hip is rare, and their prevalence is not known.

Case Report:

A 7-year-old female child presented with pain and limp left hip for 6 weeks. She had a stiff hip gait. Clinical examination revealed a fixed abduction, flexion deformity, and restricted internal rotation with apparent lengthening of 2 cm. The ultrasonography revealed synovial effusion with synovial deposits. Magnetic resonance imaging revealed features of tuberculous synovitis, inflammatory synovitis, or a rare possibility of SC. Arthrotomy was performed following failed hip aspiration. Multiple chondral loose bodies were noted on incision of capsule. Partial synovectomy was also performed. The synovium histopathology revealed multiple synovial chondral inclusions. A final diagnosis of SC was made.

Conclusion:

We report this case of primary SC, 7-year-old female patient with symptoms of hip pain, limp, and fixed deformities restricting hip function as a first of its kind in the mentioned age group. Hence, although rare SC may be considered as one of the differential diagnosis in hip symptoms in children <10 years of age.