Surgical Treatment of Synovial Osteochondromatosis of the Hip Using a Modified-Hardinge Approach with a Z-Shaped Capsular Incision

Abstract

Synovial osteochondromatosis of the hip is a rare condition, and the surgical treatment approach for this condition requires complete removal of loose bodies combined with synovectomy. While these, procedures are generally accepted as the optimal treatment method, this is still controversial topic. Recent studies have reported that open surgical procedures remain acceptable for synovial osteochondromatosis of the hip. These procedures include the dislocation of the femoral head, and complications such as femoral head necrosis and bursitis or great trochanter non-union due to trochanteric osteotomy have been reported. The present study reports a modified technique for surgical dislocation through a Z-shaped capsular incision without trochanteric flip osteotomy for the treatment of synovial osteochondromatosis of the hip.

Keywords: Hip; Z-shaped capsular incision; modified-Hardinge approach; surgical dislocation; synovial osteochondromatosis.

Figure 1.

Primary synovial chondromatosis of the right hip in a 58-year-old woman (A,B) and in a 57-year-old man (C,D). A) Preoperative anterior-posterior radiographs demonstrates multiple calcified nodules filling around the femoral neck and joint-space narrowing the right hip joint. B) T2-weighted magnetic resonance indicates the presence of synovial thickening and multiple loose bodies with low signal intensity around the femoral neck and inferomedial portion of the capsular sac. C) Preoperative anterior-posterior radiographs indicates indistinct calcification and slight joint-space narrowing the right hip joint. D) T2-weighted magnetic resonance shows the presence of synovial proliferation and configuration of intra-articular bodies.

Figure 2.

The gross photograph of the removed loose bodies.

Figure 3.

A) Surgical procedure 1. The anterior one-third of the gluteus medius muscle was incised from the anterior portion of the base of the great trochanter and the gluteus minimus tendon is divided as a single flap from its attachment to the greater trochanter. *The greater trochanter; **the gluteus medius muscle. B) Surgical procedure 2 (Z-shaped capsular incision). The capsule is first incised along with the longitudinal axis of the femoral neck (1). The second incision was made from lateral end of the first incision to anterosuperior on the lessor trochanter (2). The 3rd incision was made from the medial end of the first incision at acetabular rim. It was sharply turned posteriorly to the anterosuperior of the piriformis tendon (3). *The greater trochanter; **the vastus lateralis muscle. C) Surgical procedure 3. The surgical anterior dislocation was performed and the femoral head and neck retracted posteriorly.