Today's News

Thursday, February 13, 1997

Hip arthroscopy eases patients' pain

Hip arthroscopy is a valuable technique for both the diagnosis and treatment of synovial chondromatosis, researchers said in scientific paper 4 to be presented Thursday by J. Bohannon Mason, MD, Charlotte Hip and Knee Center, Charlotte Orthopaedic Specialists, Charlotte, N.C.

Between January 1992 and December 1995, 10 patients (six females, four males; mean age: 42) with this benign, rare, monoarticular arthropathy were treated with hip arthroscopy on an outpatient basis and followed for an average of 34 months. Patients reported significant improvement in their pain postoperatively, and all have returned to work.

Patients were symptomatic for a minimum of one year prior to surgery. Average duration of symptoms was 43 months (range: one to 11 years).

The doctors performed partial synovectomy on all patients. The authors of the paper said that "it is not possible to perform a complete synovectomy with the arthroscope, however, the perilabral synovial tissue, the synovium overlying the ligamentum teres and the inferior capsular synovium can be easily visualized and removed with hip arthroscopic techniques."

At latest follow-up, seven patients are pain-free; two patients reported occasional, mild pain; and one reported recurrence of his preoperative symptoms, although he did have relief for one year, postoperatively. Seven of eight patients are back to participating in their regular sports/leisure activities.

The researchers found that "an average of 35 loose bodies were removed at the time of arthroscopy. Most of these were nonossified and were adherent to the synovium or within the region of the fovial soft tissue.

"Loose bodies within the hip capsule are easily visualized using a 30 or, occasionally, a 70 degree arthroscope. Free-floating loose bodies often are removed with simple lavage, however larger loose bodies require morcellation and removal with motorized shavers or special alligator clamps."

The doctors found chondromalacia of the femoral head or corresponding acetabulum in most patients-two had Grade I changes (20 percent); six patients, Grade II changes (60 percent). No patient demonstrated Grade III chondromalacia. "There was no correlation between the age of the patients and the grade of chondromalacia recorded," they said, noting that two patients in the study had labral changes. "The anterior labrum was mildly frayed but otherwise stable."

The authors pointed out that traditional management of synovial chondromatosis has been with open synovectomy, but complications include osteonecrosis, muscle weakness, restriction of motion, deep venous thrombosis, progressive osteoarthritis and recurrence of loose bodies.

"Arthroscopy avoids the considerable dissection, prolonged rehabilitation and potential complications of open hip arthrotomy and synovectomy," they said. "Radiation is ineffective and may result in post-irradiation sarcomatous change.

"Synovial chondromatosis infrequently involves the hip joint, yet when present, may account for long delays in accurate diagnosis, and initiation of appropriate treatment. Bone scans may demonstrate focal increased activity in the affected joint, but remain nonspecific and MRI often fails to demonstrate nonossified loose bodies. However, gadolinium-enhanced MRI may increase the diagnostic yield."

In all cases, close clinical follow-up is recommended. "The recurrent disease may be managed with either repeat arthroscopy or with formal open synovectomy," the researchers said. "It should be individualized on a case by case basis."

Co-authors of the study with Dr. Mason are: Steven R. Wardell, MD, Parkview Orthopaedic Group, Chicago, Ill.; James Bono, MD, assistant clinical professor of orthopaedic surgery, Tufts University School of Medicine, Boston, Mass.; Brian Busconi, MD, assistant clinical professor of orthopaedic surgery, University of Massachusetts Medical Center, Worcester, Mass.; and Joseph C. McCarthy, MD, associate clinical professor of orthopaedic surgery, Tufts University School of Medicine, Boston.