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

Abstract

BackgroundThe purpose of our study was to evaluate the usefulness of hip arthroscopy including extensive capsulectomy for synovial chondromatosis of the hip.MethodsFrom 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.ResultsEight 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.ConclusionsArthroscopic 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.

Longitudinal Assessment of Clinical Outcomes After Arthroscopic Treatment for Hip Synovial Chondromatosis and the Effect of Residual Loose Bodies: Minimum 4-Year and 8-Year Follow-up

“…8 Therefore, we have developed a standardized protocol to maximize the removal of loose bodies and synovium. 25 Applying this technique in the current study, we found that 14 of 23 patients (60.8%) had residual loose bodies, which was lower than 7 of 9 (77.8%) patients reported by Lee et al 12 Most of the residual loose bodies presented at the posterior capsule and posterior acetabular fossa on CT, areas that pose challenges for arthroscopic access. Extended incision of the lateroposterior joint capsule could also cause migration of loose bodies to outside of the joint, such as to the obturator externus and subcutaneous area.…”

“…27 Therefore, concern regarding the necessity of reoperation due to residual loose bodies has been addressed. Lee et al 12 reported that 7 patients with residual loose bodies showed improvement of PROs, including VAS (from 5.4 to 4.0), mHHS (from 80.4 to 90.1), University of California, Los Angeles, score (from 4.4 to 4.8), and Western Ontario and McMaster Universities Osteoarthritis Index score (from 24.2 to 14.6), with no recurrence at a mean follow-up of 3.8 years. However, a control group was not included in their study, which may preclude drawing precise conclusion.…”

“…1,11,13,15,27 Recurrence is also a concern after arthroscopic surgery due to the difficulties of complete removal of loose bodies and synovectomy when using an arthroscopic technique. 12 The percentage of recurrence identified by a combination of clinical symptoms and imaging findings was systematically reported to be 7.1%, with 85.7% of those patients undergoing subsequent surgery (revision surgery or conversion to THA). 7 Therefore, determining the dynamic changes in functional status and survival at short-and long-term follow-up after hip arthroscopy and exploring the effect of residual loose bodies on clinical outcomes could provide valuable information for orthopaedic surgeons in treating SC.…”

Synovial Chondromatosis of Hip Joint in a Patient with Ankylosing Spondylitis: A Case Report

“…A study has recommended Magnetic Resonance Imaging (MRI) as a more sensitive diagnostic study than other studies. 8 MRI has the advantage that it can delineate cartilage clearly and can show the cartilaginous bodies which appear as signal voids on all sequences and are sometimes surrounded by bright signal intensity on T2-weighted images. Technetium bone scans through nonspecific can be of some benefit in a few cases.…”

“…If the symptoms are not relieved by conservative treatments, surgical intervention is recommended for symptomatic patients with synovial chondromatosis of the hip. 8 Complete synovectomy has been found to reduce the rate of recurrence. 1 Another major concern besides recurrence is the malignant transformation.…”