Operative treatment of primary synovial osteochondromatosis of the hip

Management of Primary Synovial Osteochondromatosis in the Ankle Joint With a Combined Posterior-Anterior Arthroscopic Procedure: A Case Report

Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the ankle joint. Controversy exists regarding whether a combined posterior-anterior approach with total synovectomy is necessary to avert recurrence or malignancy. An 18-year-old Caucasian male presented to the outpatient clinic with clinical and imaging findings indicative of a stage III PSO. The surgical intervention involved a combined posterior-anterior arthroscopic approach with the removal of multiple loose bodies and complete synovectomy, resulting in complete relief of symptoms without recurrence at the 12-month follow-up. Pathological examination confirmed the diagnosis. The management of PSO in the ankle joint using a combined posterior-anterior arthroscopic approach with complete synovectomy demonstrated effectiveness in this case. Regular follow-ups are essential for monitoring long-term outcomes and detecting potential recurrence or malignant transformation.

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.

De Novo Synovial Chondromatosis following Primary Total Knee Arthroplasty: A Case Report

In this case report, we present a rare case of a female patient who developed pain and swelling after a total knee arthroplasty. An extensive diagnostic workup including serum and synovial testing to rule out infection was performed in addition to advanced imaging including an MRI of the knee, but it was only after an arthroscopic synovectomy that the diagnosis of secondary synovial chondromatosis was confirmed. The purpose of this case report is to highlight the occurrence of secondary synovial chondromatosis as a rare cause of pain and swelling after total knee arthroplasty, thereby assisting clinicians in providing prompt diagnosis, surgical treatment, and efficient recovery in the setting of secondary synovial chondromatosis after total knee arthroplasty.

Primary synovial chondromatosis of the hip joint (PrSC of the hip): A retrospective cohort analysis and review of the literature

Introduction

Primary synovial osteochondromatosis (SOCM) or Synovial chondromatosis (SC) of the hip is a benign metaplastic condition of the synovium that is rare and may present with a spectrum of clinical features and radiological findings.

Patients and methods

A retrospective search using the keyword 'Synovial chondromatosis' (SC) of the hip was performed at a tertiary care orthopaedic referral centre in the UK and a hospital in India. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS), over 15 years. The patient's data was collated with Electronic Patient Records (EPR), RIS, and correlated with histo-pathology laboratory records where available. The demographic details of the patients, their clinical symptoms, imaging details, and management outcomes were collected.

Results

We found 15 cases, with a mean age of 36.53 years (range: 14-50 years). There were 9 male and 6 female patients. The follow-up ranged from 1 year to 6 years. Predominantly unilateral presentation with insidious onset of symptoms was found. A spectrum of radiological Imaging was undertaken. Management strategies included supervised observation, arthroscopic or open synovectomy, and hip arthroplasty. No malignant transformation was found in the analysed cohort.

Conclusion

Primary 'Synovial chondromatosis' of the hip had a male preponderance in our cohort, presenting with a range of clinical features. Radiologically, Magnetic Resonance Imaging (MRI) was the commonest modality of cross-sectional imaging utilised and crucial for the diagnosis, evaluating underlying articular involvement including guiding appropriate patient management presenting with Primary 'Synovial chondromatosis' of the hip.

Surgical hip dislocation for treatment of synovial chondromatosis of the hip

PURPOSE

In the present study, we aimed to evaluate the clinical outcomes of surgical hip dislocation in patients with synovial chondromatosis (SC) of the hip.

METHODS

Seven patients with primary SC of the hip treated with open synovectomy and removal of loose bodies by surgical hip dislocation from 2016 to 2019 were retrospectively reviewed. All patients had numerous and widespread loose bodies based on pre-operative images, including routine radiographs, CT, and MRI. The visual analog scale (VAS) score and Harris hip score (HHS) were collected and analyzed before and after surgery. The post-operative radiographs were reviewed to evaluate disease recurrence and osteoarthritis progression.

RESULTS

The mean operative time was 61 minutes (range, 42-75 min). An average of 33 loose bodies in each patient (range, 16-67) was removed, and extra-articular pathology was found in one patient. Patients were followed up for a mean duration of 30 months (range, 18-42 months). The average VAS scores were decreased from 3.7 (range, 2-6) pre-operatively to 0.9 (range, 0-2) at the last follow-up, and the HHS was improved from 60.1 (range, 50-73) to 90.1 (range, 82-95). All results demonstrated significant improvements (P < 0.05). Post-operative radiographs showed no recurrence, osteoarthritis progression, or osteonecrosis of the femoral head in all hips.

CONCLUSIONS

Surgical hip dislocation was a practical approach for managing both intra-articular and extra-articular pathologic lesions around the hip. It was an effective treatment for SC of the hip with short surgical time, good joint functions, a lower recurrence rate, and few complications.

A Rare Benign Tumor With Diagnostic Difficulties: Synovial Chondromatosis

In this article, we present a case of a 47-year-old male patient presenting with an insidious onset of hip pain and loss of range of motion. The patient was initially treated conservatively to no avail. Detailed investigations included magnetic resonance imaging of the left hip which revealed a synovitis. Blood results were unremarkable apart from moderately raised inflammatory markers. Differential diagnoses of both intra- and extra-articular hip pain were ruled out and the patient treated for a preliminary diagnosis of psoriatic arthritis for a total of six months. Persistent pain resulted in a re-visit of the diagnosis and further clinical evaluation. This time, an X-ray of the hip revealed calcification at the joint. A computed tomography followed and revealed synovial thickening and intra-articular calcification. A biopsy was consistent with primary synovial chondromatosis (SC). Open synovectomy was performed approximately one year after the onset of symptoms. This case emphasizes the importance of re-visiting initial evaluations and diagnoses when faced with a difficult case of persistent hip pain so to avoid misdiagnosis and unnecessary pharmacological treatment. In view of its rarity and diagnostic challenges, future work on SC should concentrate on gathering data which can be used to produce a diagnostic algorithm.

Management of synovial chondromatosis of the hip by open arthrotomy debridement only VS total hip replacement: A case report

•

Both arthrotomy debridement only or followed by total hip replacement could be an option in treating synovial chondromatosis of the hip.

•

Both treatment option shows a successful outcome by HHS and LEFS questionnaires without any recurrence marks.

•

Grade of osteoarthritis and patient age can be a distinguish factor for choosing a treatment option.

Introduction

Synovial chondromatosis is an unusual nonneoplastic condition of joints. Clinical symptoms usually insidious, and the patient often came in the late stage of the disease. Treatment generally include arthroscopy debridement, open arthrotomy debridement to evacuate loose bodies, or in a very late stage with a collapsing joint, it might need a joint replacement arthroplasty.

Methods

We report two cases of a 55-year old and a 22-year-old man with synovial chondromatosis of the hip. Both patients came with hip pain, but the former presents at a late stage with osteoarthritis of the hip. The former underwent open arthrotomy debridement to evacuate loose bodies, synovectomy then followed by a total hip replacement. The latter underwent open arthrotomy debridement only to evacuate loose bodies and synovectomy without performing dislocation of the hip. Postoperative outcome was evaluated using plain hip x-ray, pain scale with VAS, and functional score with Harris Hip Score (HHS).

Results

At 1-year follow up, both subjects demonstrate an improving functional outcome. The former patient had an improved HHS from 39 to 91 while the latter had an improved HHS from 68 to 93. With complete removal of the metaplastic tissue and synovectomy, the recurrence of the chondromatosis is not apparent yet until now.

Discussion

Arthrotomy debridement only or arthrotomy debridement followed by total hip replacement can be considered as an option in treating synovial chondromatosis of the hip as both show a successful outcome. A selective method of treatment must be considered in our decision making for each individual.

A Novel High-Throughput Screening Platform Identifies Itaconate Derivatives from Marine Penicillium antarcticum as Inhibitors of Mesenchymal Stem Cell Differentiation

Worldwide diffused diseases such as osteoarthritis, atherosclerosis or chronic kidney disease are associated with a tissue calcification process which may involve unexpected local stem cell differentiation. Current pharmacological treatments for such musculoskeletal conditions are weakly effective, sometimes extremely expensive and often absent. The potential to develop new therapies is represented by the discovery of small molecules modulating resident progenitor cell differentiation to prevent aberrant tissue calcification. The marine environment is a rich reserve of compounds with pharmaceutical potential and many novel molecules are isolated from macro and microorganisms annually. The potential of small molecules synthetized by marine filamentous fungi to influence the osteogenic and chondrogenic differentiation of human mesenchymal stem/stromal cells (hMSCs) was investigated using a novel, high-throughput automated screening platform. Metabolites synthetized by the marine-derived fungus Penicillium antarcticum were evaluated on the platform. Itaconic acid derivatives were identified as inhibitors of calcium elaboration into the matrix of osteogenically differentiated hMSCs and also inhibited hMSC chondrogenic differentiation, highlighting their capacity to impair ectopic calcification. Bioactive small molecule discovery is critical to address ectopic tissue calcification and the use of biologically relevant assays to identify naturally occurring metabolites from marine sources represents a strategy that can contribute to this effort.

Synovial chondromatosis of the hip, a case report and literature review

A case of giant synovial chondromatosis of the hip with extra-articular localisation in the ileopectineal bursa is presented and the literature concerning this condition is reviewed. Synovial chondromatosis is a rare condition of unknown aetiology. A literature search was performed to identify studies describing outcome after surgical treatment of synovial chondromatosis of the hip. Thirteen studies including two hundred-ninety patients could be included. Mean follow-up was fifty-six months. Seven out of two hundred-ninety developed a complication after surgical resection of the lesion. Recurrence rate of synovial chondromatosis is about 19%. Malignant transformation of synovial chondromatosis to chondrosarcoma is extremely rare. No wound infections were reported and avascular necrosis of the femoral head occurred in one patient who was treated with dislocation of the hip during surgery. After resection of synovial chondromatosis excellent functional outcome can be expected.

Remaining Loose Bodies after Arthroscopic Surgery Including Extensive Capsulectomy for Synovial Chondromatosis of the Hip

Background

The purpose of our study was to evaluate the usefulness of hip arthroscopy including extensive capsulectomy for synovial chondromatosis of the hip.

Methods

From 2008 to 2016, 13 patients with synovial chondromatosis of the hip were treated with arthroscopic removal of loose bodies and synovectomy using three arthroscopic portals. An extensive capsulectomy was performed to allow the remaining loose bodies to be out of the extracapsular space, and the excised capsule was not repaired. All patients were assessed by clinical scores and the radiographs were reviewed to determine whether the remaining loose bodies disappeared at the last follow-up.

Results

Eight men and two women were followed up for a minimum of 1 year (mean, 3.8 years; range, 1 to 6.8 years) after hip arthroscopy. Clinical outcomes such as modified Harris hip score, University of California Los Angeles score, and Western Ontario and McMaster Universities Osteoarthritis Index score improved at the last follow-up. Although seven hips had remaining loose bodies after arthroscopic surgery, the remaining loose bodies disappeared in five hips (71.4%) at the last follow-up.

Conclusions

Arthroscopic surgery was useful to treat synovial chondromatosis of the hip. In spite of limited removal of loose bodies, arthroscopic procedures including extensive capsulectomy could be effective for the treatment of synovial chondromatosis of the hip.

Primary Synovial Osteochondromatosis of the Hip Joint Treated with Arthroscopic-assisted Mini-open Surgery-Two Case Reports

Introduction:

Primary synovial osteochondromatosis of the hip joint is a rare condition. It is characterized by the presence of multiple intra-articular loose bodies and can result in mechanical symptoms, even causing degenerative change. Surgical treatment is indicated for synovial osteochondromatosis of the hip joint. However, the optimal approaches for successful surgical management are still controversial.

Case Report:

We report two cases with primary synovial osteochondromatosis of the hip joint where arthroscopic-assisted mini-open surgical treatmentwas performed. The posterior approach was used, and a minimal arthrotomy was performed with preservation of bloody supplement of thefemoral head. With the assistance of an arthroscope, synovectomy, debridement, and loose body removal were completed without dislocating the femoral head. The follow-up duration was 5years and 2.5 years, respectively. There were no perioperative or post-operative complications. At the latest follow-up, the patients remain symptom free with no radiographic evidence of recurrence.

Conclusions:

Our arthroscopic-assisted mini-open method could achieve the goals of extensive synovectomy, debridement, and loose body removal, thus reducing the recurrence rate. This method avoids dislocation of the femoral head, thus reducing the occurrence of surgical complications.

[Effectiveness of arthroscopy for synovial chondromatosis of hip joint]

Objective

To evaluate the effectiveness of arthroscopy for synovial chondromatosis of hip joint.

Methods

Between April 2012 and September 2015, 32 patients with synovial chondromatosis of hip joint were treated by arthroscopy. There were 19 males and 13 females, with an average age of 42.1 years (range, 22-64 years). The synovial chondromatosis located at right hip in 15 cases and left hip in 17 cases. The main clinical symptoms were pain and swelling of hip joint. Of all patients, 6 cases were hip hinge, 2 cases were lower limb weakness, and 1 case was snapping hip. The "4" sign was positive in 9 cases, Thomas' sign positive in 4 cases, and rolling test positive in 2 cases.

Results

All incisions healed by first intention, and no complication occurred. All patients were followed up 16-48 months (mean, 33.8 months). The visual analogue scale (VAS) was 1.4±0.8 at last follow-up, which was significantly lower than that before operation (4.8±1.2) ( t=6.382, P=0.013). The hip Harris score was 92.6±6.7 at last follow-up, which was significantly higher than that before operation (63.2±8.3) ( t=9.761, P=0.006). At last follow-up, the "4" sign and Thomas' sign were positive in 3 cases and 1 case, respectively. The others had no positive sign. X-ray film showed no recrudescence in all cases.

Conclusion

Treating synovial chondromatosis of hip joint under arthroscopy has advantages of less trauma, complete debridement, quick postoperative recovery, and the satisfactory short-term effectiveness.

Extra-Articular Tenosynovial Chondromatosis of the Finger: A Case Series Study of Three Cases, One Including Excessive Osseous Invasion

BACKGROUND

Synovial chondromatosis is characterized by cartilaginous metaplasia in synovial tissues. Extra-articular tenosynovial chondromatosis is considered to be an anatomical counterpart of articular synovial chondromatosis. Extra-articular tenosynovial chondromatosis occurs preferentially in the hand, although its frequency is low.

RESULTS

We report three cases of extra-articular tenosynovial chondromatosis. A 65-year-old female presented with a history of symptoms over 40 years related to the dorsum of her index finger (Case 1), A 46-year-old female presented with a 6-month history of symptoms at the volar surface of her middle finger (Case 2), and a 66-year-old male presented with a 3-month history of symptoms in a dorsal ring finger. Case 2 had evidence of ossification, which could be classified as osteochondromatosis. Interestingly, the index finger lesions (Case 1) were accompanied by excessive bone involvement. The signal intensity of T2-weighted magnetic resonance imaging varies from low to high, possibly reflecting histological variations, such as ossification and fatty tissue changes. All lesions were resected without complications.

CONCLUSION

Variations in anatomical sites suggest that overuse or mechanical overloading was not causative. Extensive involvement of the nearby tendon and joint capsule, as well as the bone, would require attention during the resection. Preoperative analysis of images is important, not only for the diagnosis, but also to assess the extent of the lesion, particularly given the complex anatomy of the finger.

A systematic literature review of synovial chondromatosis and pigmented villonodular synovitis of the hip

OBJECTIVES

Benign synovial diseases of the hip including Synovial Chondromatosis (SC) and Pigmented Villonodular Synovitis (PVNS) are devastating diseases. Initially, patients present with hip pain unrelieved by conservative measures. The diagnosis of PVNS and SC are often delayed, leading to progression of joint damage. The purpose of this review is to present the latest on the diagnosis, management, and prognosis of SC and PVNS of the hip.

METHODS

An extensive systematic search of MEDLINE and PUBMED Databases was performed. Data parameters were set from 2005 to present day with set inclusion criteria. Systematic reviews were excluded.

RESULTS

427 abstracts were identified, with 12 articles meeting all inclusion criteria. Eight studies focused on SC, and 5 on PVNS. 233 patients with SC of the hip and 98 patients with PVNS of the hip were identified, a total of 331 patients.

DISCUSSION

Benign Synovial disorders of the hip are rare. In patients with chronic hip pain secondary to benign synovial disorders, early diagnosis and surgical intervention demonstrate good outcomes, and patients may benefit due to prevention of morbidity from further joint destruction. There is no clear consensus between higher successes through open versus arthroscopic surgical debridement. In the final phase of benign synovial disorders of the hip, THA of different types based on the patient's age should be considered.

Is early treatment of cam-type femoroacetabular impingement the key to avoiding associated full thickness isolated chondral defects?

PURPOSE

Hip arthroscopy is a safe and reproducible method for treating femoroacetabular impingement (FAI) and has evolved greatly in recent years. But little is known about the influences on the outcome after surgery. The aims of the current study were to elucidate (1) which parameters can be used as a marker for the presence of chondral and labral lesions, (2) the postoperative clinical outcome, and (3) at which time after surgery recovery occurs.

METHODS

A prospective study was performed with 177 patients who underwent hip arthroscopy because of cam-type FAI. The patients were examined preoperatively as well as 6 weeks and 6 months postoperatively, and their condition was rated according to the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Non-Arthritic Hip Score (NAHS). Statistical analyses were performed to evaluate the influence of independent factors such as "patient age," "pain duration before surgery" on the clinical outcome, and the appearance of chondral or labral defects.

RESULTS

The NAHS and WOMAC scores showed a significant enhancement 6 weeks after surgery. Only the NAHS showed a further improvement after 6 months. A positive correlation with the dependent variable "chondral lesion" was evaluated for the independent variables "pain duration before surgery," "preoperative NAHS," and "labrum lesion". Using ROC analysis, the optimal cutoff value of "pain duration before surgery" as a predictor was 9.5 months, for the NAHS 42.5 points. For the dependent variable, "6-month postoperative NAHS" significant correlations for the independent variables "age" and "pain duration before surgery" were revealed with a cutoff value of 55.5 years, respectively, 23.5 months.

CONCLUSIONS

It was concluded from the results that the date of surgery is relevant for the appearance of chondral defects. Patient age is a further relevant factor for clinical outcome. Recovery after hip arthroscopy takes place mainly in the first 6 weeks after surgery.

LEVEL OF EVIDENCE

Therapeutic study, Level III.

Surgical Treatment of Synovial Osteochondromatosis of the Hip Using a Modified-Hardinge Approach with a Z-Shaped Capsular Incision

Synovial osteochondromatosis of the hip is a rare condition, and the surgical treatment approach for this condition requires complete removal of loose bodies combined with synovectomy. While these, procedures are generally accepted as the optimal treatment method, this is still controversial topic. Recent studies have reported that open surgical procedures remain acceptable for synovial osteochondromatosis of the hip. These procedures include the dislocation of the femoral head, and complications such as femoral head necrosis and bursitis or great trochanter non-union due to trochanteric osteotomy have been reported. The present study reports a modified technique for surgical dislocation through a Z-shaped capsular incision without trochanteric flip osteotomy for the treatment of synovial osteochondromatosis of the hip.

Giant extra-articular synovial osteochondromatosis of the left proximal thigh: A case report

Extra-articular synovial osteochondromatosis is a rare disease. The present study describes the case of a 46-year-old female who suffered from extra-articular synovial osteochondromatosis of the left proximal thigh with limited hip movement. The patient underwent a total tumor resection and recovered well. The tumor was 15×14×5 cm³ in size and located in the muscle gap. After a 3-month follow-up, the patient's left hip motion was improved and a computed tomography scan demonstrated no evidence of recurrence. However, the long-term efficacy of this procedure requires continuous observation of the patient. To the best of our knowledge, this is the first case of a giant extra-articular synovial osteochondromatosis of the proximal thigh muscle gap.

Arthroscopic surgery for synovial chondromatosis of the hip: a systematic review of rates and predisposing factors for recurrence

PURPOSE

Synovial chondromatosis of the hip is a benign condition whereby pain and functional limitations occur due to numerous intra-articular osteochondral fragments produced by a metaplastic synovium. Recurrence not only worsens morbidity but may lead to malignant transformation. With reported recurrence rates as high as 22% by open surgical approaches and given the increasing use of hip arthroscopy for the treatment of synovial chondromatosis, we sought to quantify the recurrence rate after arthroscopy, as well as identify predisposing factors for recurrence.

METHODS

Using predetermined inclusion criteria, 3 electronic databases--Embase, Medline, and PubMed-were searched for relevant articles addressing arthroscopic surgery for synovial chondromatosis of the hip across all available dates up to and including February 16, 2014. A hand search of the reference sections of the included studies was also completed. Article screening was conducted in duplicate. Reviewer agreement statistics and descriptive statistics of the included studies are presented.

RESULTS

From an initial retrieval of 2,542 studies, 14 studies satisfied the criteria for inclusion. A total of 197 patients (age range, 13 to 81 years) underwent hip arthroscopy for removal of intra-articular osteochondral fragments and synovectomy to alleviate both mechanical symptoms and pain. Follow-up periods ranged from 1 to 184 months, with approximately 7.6% of patients (15 of 197) lost to follow-up. The recurrence rate after hip arthroscopy was 7.1% (14 of 197), and the rate of minor complications, such as perineal and pedal neurapraxia, was 1%.

CONCLUSIONS

For synovial chondromatosis of the hip, arthroscopic removal of osteochondral fragments with synovectomy is both safe and effective, with a mean recurrence rate of 7.1%.

LEVEL OF EVIDENCE

Level IV, systematic review of Level IV studies.

Synovial chondromatosis of pes anserine bursa secondary to osteochondroma

Osteochondromas are common benign bone tumors. Synovial chondromatosis is a benign cartilaginous metaplasia that occurs in the synovium. The authors describe a unique case of synovial chondromatosis developing in the pes anserine bursa secondary to an underlying osteochondroma of the proximal medial tibia. It is unusual to see both of these processes occurring simultaneously in 1 location. After appropriate consent was obtained, the patient's case was reviewed. A 17-year-old boy presented with a painless mass in the medial aspect of the right leg. Initial imaging of the right leg showed a cartilaginous-appearing lesion arising from the tibia and several distinct additional cartilaginous masses in the adjacent soft tissue. After 16 months of observation, the patient began to have increasing pain in the region of the lesion. The patient underwent surgery for excision of suspected synovial chondromatosis of the right pes anserine bursa and osteochondroma of the proximal right tibia. Postoperatively, the patient had complete resolution of symptoms and regained full range of motion of the knee. He returned to full activities, including walking and running. Osteochondromas are common benign bone tumors. Synovial chondromatosis is a benign synovial metaplastic cartilaginous proliferation that occurs primarily in joints, but can occur in any synovial-lined space. In this case report, the authors describe a unique occurrence of both of these lesions simultaneously. The treatment was excision of the osteochondroma and resection of the chondromatosis lesions, which resulted in an excellent outcome.

Surgical dislocation of the hip for excision of benign tumours

AIM

Surgical dislocation of hip is used to treat a variety of hip conditions. We report our experience of the approach in excision of benign tumours of the hip.

METHODS

This is a review of the cases presenting with benign tumours to a tertiary care complex hip clinic. Data was collected prospectively. All patients were radiologically investigated before surgery for anatomical detail. Surgical dislocation was carried out by the senior surgeon in all cases. Non-Arthritic Young Hip Scores were done preoperatively and at 12 months. All patients are under annual follow-up.

RESULTS

There were 9 cases of benign tumours in this series including Pigmented Villonodular Synovitis (2), synovial chondromatosis (2), fibrous dysplasia (2), osteochondroma (2) and chondroblastoma (1). No recurrences, trochanteric nonunion or avascular necrosis have been seen up to a minimum of 18 months follow-up. Non-arthritic Young Hip scores improved from a mean of 45 to 89 at 12 months.

CONCLUSION

Surgical dislocation of the hip is a useful approach for removal of benign tumours of the hip joint.

Synovial osteochondromatosis of the hip with femoroacetabular impingement and osteoarthritis: a case report

Synovial osteochondromatosis is a rare, benign condition characterised by synovial metaplasia and the formation of cartilaginous and osteocartilaginous bodies in the capsule. We report one such case in a 30-year-old woman with synovial osteochondromatosis of the hip and progressive osteoarthritis caused by femoroacetabular impingement with joint-space narrowing. She underwent surgical removal of 32 loose bodies and osteochondroplasty. A coronal osteophyte at the junction of the femoral head and neck was also excised. At 2-year follow-up, her Harris Hip Score had improved from 62 to 90.

Arthroscopic management of primary synovial chondromatosis of the hip

PURPOSE

We evaluated clinical outcomes after hip arthroscopy in patients with primary synovial chondromatosis (SC).

METHODS

We retrospectively assessed 11 patients who underwent hip arthroscopy for primary SC at a mean follow-up of 22 months (range, 12 to 36 months). Clinical preoperative and postoperative evaluation was performed with the Harris hip score. The preoperative evaluation included plain radiographs and magnetic resonance (MR) scanning to detect number and positioning of intra-articular radiopaque loose bodies. The osteochondral damage was graded using the Kellgren-Lawrence classification. The chondral surfaces of both the acetabulum and femoral head were graded according to the Outerbridge scale.

RESULTS

The clinical score improved postoperatively. There were statistically significant differences between preoperative and postoperative Harris hip scores (P < .05). Outcomes were rated as very satisfactory and satisfactory in 3 and 5 of 11 patients, respectively. The osteochondral damage ranged between stages 1 and 2. No complications related to surgical procedures were observed.

CONCLUSIONS

Hip arthroscopy for the treatment of patients with primary SC showed good clinical results without any complications related to the surgical procedure. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Giant extra-articular synovial osteochondromatosis of the sinus tarsi: a case report

A 32-year-old male presented with painful swelling of the sinus tarsi that occurred during daily activities. Diagnostic imaging suggested the presence of a large synovial osteochondromatosis that blocked subtalar motion with deformity of the adjacent bone. The large bony mass was excised, and normal subtalar motion was achieved.

Extra-osseous tenosynovial chondromatosis of the middle finger: a case report

Extra-osseous tenosynovial chondromatosis is rare and has a high rate of local recurrence. We report a 23-year-old man who presented with a 6-month history of pain and swelling of the right middle finger and painful limitation of the ring finger flexion secondary to this condition. Surgical exploration revealed multiple loose bodies of varying size arising from the flexor tendon sheath. Histopathological examination revealed mature chondroid tissue and focal calcification. After 2 years of follow-up, the patient had achieved an excellent functional recovery and showed no evidence of recurrence.

Arthroscopic treatment of synovial chondromatosis of the hip

BACKGROUND

Recently, arthroscopic loose body removal and synovectomy have been performed as treatments for synovial chondromatosis of the hip joint. However, to date, no reports have been published on the outcomes of arthroscopic treatments.

HYPOTHESIS

Arthroscopic treatment is effective for synovial chondromatosis of the hip joint and has advantages such as low recurrence rates, faster return to activities of daily life, and few surgical complications.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

From June 1996 to July 2008, 24 patients with synovial chondromatosis of the hip who were followed up after arthroscopic removal of loose bodies and synovectomy were evaluated. The common arthroscopic portals were the anterior, anterolateral, and posterolateral portals. In some cases, we applied a medial portal for removal of loose bodies in the posteromedial pouch. Preoperative and postoperative assessments were made through simple radiographs, 3-dimensional computed tomography, magnetic resonance imaging, visual analog scale (VAS) for pain, range of motion of the joint, Harris Hip Score, and Merle D'Aubigné and Postel score.

RESULTS

Postoperative mean follow-up period was 41 months. There were no major complications. Patients were able to walk weightbearing on average 2 days after surgery and were discharged in an average of 3.5 days (range, 3-5 days) after surgery. In postoperative radiological imaging, 4 patients showed progression of joint osteoarthritis, and 1 of them underwent total hip arthroplasty. The VAS score before surgery was 8.1 ± 1.3 and after surgery was 3.1 ± 1.4. Range of motion of the hip joint before surgery was increased after surgery, except in 1 patient who required a third operation. Harris Hip Score before surgery was an average of 39 ± 6.9 and improved to an average of 82 ± 10.2 after surgery. Eighteen patients (75%) had good or excellent outcomes. Symptomatic disease recurred in 4 patients (16.7%), and 1 of these 4 patients showed a subsequent recurrence.

CONCLUSION

The treatment of synovial chondromatosis of the hip using arthroscopic loose body removal and synovectomy is relatively successful, and rehabilitation of patients is fast, therefore making it an effective treatment with satisfactory postsurgical results. However, a technical limitation of arthroscopy is the difficulty in approaching the posterolateral and posteromedial areas of the peripheral compartment.

Synovial osteochondromatosis of the second metatarsophalangeal joint: a case report

Synovial osteochondromatosis is usually monoarticular, involving a large joint. Common locations include the knee, elbow, shoulder, and hip. It is not very common in the ankle, and it is very rare in the smaller joints of the foot. To our knowledge, and with the exception of 4 cases that occurred in the great toe, this condition has never been described in other metatarsophalangeal joints. In this report, we presented a case of synovial osteochondromatosis in the second metatarsophalangeal joint and reviewed the literature.

Primary synovial osteochondromatosis of a subdeltoid bursa

Primary synovial osteochondromatosis (SOC) is known to be intra-articular and wherever it is observed outside a synovial joint, it is associated with the involvement of the nearby joint. Primary SOC has not been reported to involve a subdeltoid bursa. We present a case of a 52-year-old woman having a large number of loose bodies in a large tumor in the subdeltoid bursa. The swelling was first noticed by the patient 2 years back. Plain roentgenogram revealed soft tissue swelling only with no areas of calcification. On MRI, multiple nonosseous loose bodies were visualized in the bursa deep to the deltoid muscle. A surgical excision of subdeltoid bursa was done. A biopsy confirmed it to be cartilaginous loose bodies in synovial lining sugestive of metaplastic transformation of the synovial tissue.

Synovial osteochondromatosis of the hip treated through a surgical dislocation

We report a case of osteochondromatosis in the hip joint treated through a surgical dislocation and describe the use and safety of the procedure confirmed by postoperative magnetic resonance imaging. A 44-year-old man had right hip pain with moderate limitation of the range of motion. Plain radiographs and computed tomography showed calcified loose bodies in the hip with mild joint degeneration. Magnetic resonance imaging showed remarkable expansion of the capsule containing joint fluid and loose bodies below the femoral head. Complete removal of loose bodies and synovectomy were performed through a surgical dislocation. Three months after the operation, the patient had fully recovered and returned to his job. Magnetic resonance imaging performed 5 months after surgery revealed full removal of the loose bodies and no recurrence of the disease including synovial proliferation. It also showed no evidence of avascular necrosis, meaning that the procedure had been performed safely.

[Synovial chondromatosis]

Primary articular synovial chondromatosis is a benign, self-limiting neoplastic process in which hyaline cartilage nodules form in the synovial tissue. The disease most frequently affects the knee in men, followed by the elbow. The basic feature of this disease is a metaplastic maturation of the mesenchymal cells in the synovial membrane of a joint into cartilage. These cells mature into chondroblasts and form small nodules of cartilage in the synovial membrane. These nodules subsequently enlarge and detach to lie within the joint space. They become free within the joint as multiple small cartilaginous loose bodies nourished by the synovial fluid. The chondrocytes in the loose bodies continue to multiply, and the loose bodies grow in diameter. Calcification appears in the central zone of the loose bodies, and in some cases, enchondral ossification takes place. The operative therapy depends on the stage of the disease: synovectomy with removal of chondral fragments if active intrasynovial disease is present, and removal of the multiple chondral bodies alone in cases of late inactive disease with no synovial abnormalities. Malignant transformation is unusual and can be difficult to distinguish from benign disease.

ARTHROSCOPIC TREATMENT OF SYNOVIAL OSTEOCHONDROMATOSIS OF THE HIP

Objective: The objective of this study is to show the results achieved in the treatment of hip osteochondromatosis by arthroscopy. Methods: Six patients submitted to hip arthroscopy for synovial osteochondromatosis have been assessed for pre- and postoperative function and pain. The time of preoperative complaint ranged from nine to 48 months, in an average of 28.2 months and the follow-up ranged from eight to 25 months (mean: 17.1 months). Mean age was 45.1 years, with four female patients (66.6%) and the right side affected in five cases (83.3%). Results: Concerning the results according to Byrd-modified Harris' criteria, the mean score evolved from 54.1 to 90.4, and the mean score on the face expressions scale for pain assessment ranged from 1.7 to 5.1. Conclusion: arthroscopy is a good alternative for hip osteochondromatosis treatment, although longer follow-up times are required to strictly stating this. The results found so far are encouraging, constituting a littleinvasive procedure allowing good recovery.

Arthroscopy in primary synovial chondromatosis of the hip: description and outcome of treatment

Between 1985 and 2000, 120 patients underwent arthroscopic management for primary synovial chondromatosis of the hip. We report the outcome of 111 patients with a mean follow-up of 78.6 months (12 to 196). More than one arthroscopy was required in 23 patients (20.7%), and 42 patients (37.8%) went on to require open surgery. Outcomes were evaluated in greater detail in 69 patients (62.2%) treated with arthroscopy alone, of whom 51 (45.9%) required no further treatment and 18 (16.2%) required further arthroscopies. Of the 111 patients, 63 (56.7%) had excellent or good outcomes. At the most recent follow-up, 22 patients (19.8%) had undergone total hip replacement. Hip arthroscopy proved beneficial for patients diagnosed with primary synovial chondromatosis of the hip, providing good or excellent outcomes in more than half the cases.

Benign synovial disorders

Collectively, benign synovial disorders are not uncommon, and they may be seen in general orthopaedic practices. Symptoms are nonspecific, often delaying diagnosis. In fact, synovial chondromatosis, pigmented villonodular synovitis, synovial hemangioma, and lipoma arborescens often mimic each other as well as other, more common joint disorders in presentation, making diagnosis extremely difficult. It is important to diagnose these disorders correctly in order to provide appropriate treatment and avoid secondary sequelae, such as bone erosion and cartilage degeneration.

Arthroscopic synovectomy, removal of loose bodies and selective biceps tenodesis for synovial chondromatosis of the shoulder

We retrospectively identified 18 consecutive patients with synovial chrondromatosis of the shoulder who had arthroscopic treatment between 1989 and 2004. Of these, 15 were available for review at a mean follow-up of 5.3 years (2.3 to 16.5). There were seven patients with primary synovial chondromatosis, but for the remainder, the condition was a result of secondary causes. The mean Constant score showed that pain and activities of daily living were the most affected categories, being only 57% and 65% of the values of the normal side. Surgery resulted in a significant improvement in the mean Constant score in these domains from 8.9 (4 to 15) to 11.3 (2 to 15) and from 12.9 (5 to 20) to 18.7 (11 to 20), respectively (unpaired t-test, p = 0.04 and p < 0.0001, respectively). Movement and strength were not significantly affected. Osteoarthritis was present in eight patients at presentation and in 11 at the final review. Recurrence of the disease with new loose bodies occurred in two patients from the primary group at an interval of three and 12 years post-operatively. In nine patients, loose bodies were also present in the bicipital groove; seven of these underwent an open bicipital debridement and tenodesis. We found that arthroscopic debridement of the glenohumeral joint and open debridement and tenodesis of the long head of biceps, when indicated, are safe and effective in relieving symptoms at medium-term review.

Imaging of Synovial Chondromatosis with Radiologic-Pathologic Correlation

Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical "ring-and-arc" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.