Arthroscopic Treatment of Synovial Chondromatosis of the Hip

• Published in: The American journal of sports medicine Vol. 40; no. 6; pp. 1412 - 1418
• Main Authors: Lee, Jung-Bum, Kang, Chan, Lee, Chang-Hwan, Kim, Pil-Sung, Hwang, Deuk-Soo
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-06-2012; Sage Publications; Sage Publications Ltd
• Subjects: Adult; Arthroplasty, Replacement, Hip - methods; Arthroplasty, Replacement, Hip - rehabilitation; Arthroscopy; Arthroscopy - methods; Arthroscopy - rehabilitation; Biological and medical sciences; Chondromatosis, Synovial - diagnostic imaging; Chondromatosis, Synovial - rehabilitation; Chondromatosis, Synovial - surgery; Diseases of the osteoarticular system; Endoscopy; Female; Hip - diagnostic imaging; Hip - surgery; Hip joint; Humans; Investigative techniques, diagnostic techniques (general aspects); Joint Loose Bodies - diagnostic imaging; Joint Loose Bodies - surgery; Joint surgery; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Osteoarthritis - surgery; Pain Measurement; Patients; Radiography; Range of Motion, Articular - physiology; Recurrence; Sports medicine; Treatment Outcome; Tumors of striated muscle and skeleton; Walking - physiology; arthroscopic loose body removal; arthroscopic synovectomy; synovial chondromatosis; hip joint; Hip joint; Diseases of the osteoarticular system; Hip; Synovial chondromatosis; Arthroscopy; Treatment; Ergonomics; Surgery; Arthropathy; Endoscopy; Synovectomy
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546512445150

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.