THE EFFECTIVENESS AND THE TECHNICAL DIFFICULTIES OF HIP ARTHROSCOPY IN SYNOVIAL OSTEOCHONDROMATOSIS IN A SERIES OF 3 PATIENTS

The effectiveness and the technical difficulties of hip arthroscopy in synovial osteochondromatosis in a series of 3 patients
Tzaveas A.
Interbalkan Medical Centre of Thessaloniki
Purpose of the study
Synovial osteochondromatosis is characterised by metaplasia of the synovium, resulting in the formation of nodules which transform into chondral or osteochondral bodies. Traditionally, the procedure of choice in the management of the condition in the hip was open removal of the bodies and debridement of the joint. The aim of this study is to assess arthroscopy in synovial osteochondromatosis of the hip and to record the technical difficulties.
Material and method
The cases of three patients with primary synovial osteochondromatosis of the hip who underwent hip arthroscopy were studied. In two of the three patients the first diagnosis had been made 10 years earlier and in the third 15 years earlier. One patient had previously undergone open arthrotomy and debridement 12 years earlier, while two had undergone arthroscopy 5 years earlier. Because of deterioration in their symptoms and in the radiographic and MRI appearances, the patients underwent a further arthroscopic procedure. One patient had Milgram stage 2 disease, while two had stage 3. The technical difficulties encountered during arthroscopy and the outcome of the procedure were recorded, at a maximum follow-up of 30, 12 and 6 months respectively for the three patients.
Results
In all three patients an attempt was made to remove as many bodies as possible, together with an extensive synovectomy. In the patient with Milgram stage 3 disease an extensive capsulotomy was also carried out, as the joint was markedly stiff. In the same patient no loose bodies were found in the central compartment, only in the peripheral compartment, but advanced chondral lesions in the form of generalised osteoarthritis were identified. The technical difficulties include the difficulty of entering the central compartment, the difficulty of viewing the peripheral compartment when it is full of loose bodies, the inability to remove all the bodies, the inability to reach the posterior peripheral compartment, and the inability to perform a synovectomy over the whole extent of the capsule. Nevertheless, all the patients showed considerable improvement both in the range of motion of the joint and in their pain levels. The detailed assessment of function and pain was made with the modified Harris Hip Score.
Conclusions
Hip arthroscopy is a good option in the management of synovial osteochondromatosis of the hip, offering all the advantages of a minimally invasive technique, with a very short hospital stay and very low morbidity. It has, however, the disadvantage that it cannot reach every recess of the joint, which the open method achieves. Given that it offers considerable relief from the symptoms, the question of whether to choose an arthroscopic or an open technique in osteochondromatosis of the hip should be the subject of further study.