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Efficacy of hip arthroscopy in the management of synovial chondromatosis.
MedLine Citation:
PMID:  21709042     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Synovial chondromatosis can result in intra-articular loose bodies. Open arthrotomy has been the conventional treatment for this condition in the hip. Hip arthroscopy, however, is a minimally invasive approach and avoids potential problems with open arthrotomy.
PURPOSE: This series was described to evaluate the role of arthroscopy in treatment and outcome of synovial chondromatosis of the hip at early to intermediate follow-up.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: Twenty-nine patients had arthroscopic treatment for synovial chondromatosis of the hip. All loose bodies were intracapsular and smaller than 10 mm. Radiographs of the painful hip, computed tomography (CT), and gadolinium-enhanced magnetic resonance imaging (MRI) were obtained preoperatively. Intraoperatively, loose bodies were removed, and partial synovectomy, partial labrectomy, chondroplasty, and microfracture were done as needed.
RESULTS: There were 14 women and 15 men (mean age, 41 years; mean duration of symptoms, 52 months). All patients had hip pain and 63% reported mechanical hip symptoms. Twenty-three patients were followed for at least 12 months (mean, 64 months). Loose bodies could be seen in the imaging studies of 52% of patients: 8 on radiographs and 7 with CT or gadolinium-enhanced MRI. At surgery, 23 of the 29 (79%) patients had torn labra and femoral head changes. There were an average of 35 loose bodies per patient. Twenty-five of the 29 (86%) had acetabular chondral findings. Five of the 29 patients (17%) eventually underwent total hip reconstruction surgery at a mean of 52 months; 5 of these patients had grade III/IV lesions at the time of arthroscopy. Eleven of the 23 patients (48%) had good to excellent outcomes at an average of 60 months. Recurrent symptoms were seen in 7 patients, and revision arthroscopy was done for 1 patient at 1-year follow-up, 2 patients at 4 years, 1 at 5 years, and 1 at 7-year follow-up. Complications included transient perineal and pedal paresthesia in 2 patients.
CONCLUSION: Patients with synovial chondromatosis with hip central compartment loose bodies that were less than 10 mm benefited from hip arthroscopy. Imaging studies alone failed to establish the diagnosis in 14 of 29 patients (48%). Diagnosis was made by direct visualization via arthroscopy. For patients with grade I/II cartilage change, early diagnosis and treatment via arthroscopy helped. It is a valid and effective treatment at early to intermediate follow-up.
Authors:
Anthony Marchie; Ian Panuncialman; Joseph C McCarthy
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of sports medicine     Volume:  39 Suppl     ISSN:  1552-3365     ISO Abbreviation:  Am J Sports Med     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7609541     Medline TA:  Am J Sports Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  126S-31S     Citation Subset:  IM    
Affiliation:
Joseph C. McCarthy, Newton-Wellesley Hospital, Joint Reconstruction Center, 2000 Washington Street, Suite 361 GR, Newton MA 02162. jcmccarthy1@partners.org.
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