Surgical Dislocation of the Hip through Lateral Approach for the Treatment of Synovial Chondromatosis

Abstract

Introduction: Synovial chondromatosis is a condition where the cells lining a joint form benign cartilaginous tumors. This benign cartilage metaplasia results in the formation of multiple intra-articular loose bodies within a joint.

Case report: This case is a 59-year-old female that presented with constant, severe left hip pain that was localized to the groin and began 2 years ago. There were severe limitation of hip flexion, extension, pain on internal rotation, and a half inch left leg shortening. Radiographs demonstrated multiple round opacities surrounding the left femoral neck. MRI showed numerous, small rounded intra-articular loose bodies, measuring about 5-6 mm each within the left hip joint.

Surgical technique: A lateral approach toward the hip was used to perform an osteotomy at the portion of the greater trochanter. The hip capsule was identified and an S-shaped incision was then made through the capsule. Repetitive hip dislocations allowed for improved visualization making further removal of the difficult fragments much easier. The capsule was closed and the osteotomy was reattached. Range of motion was found to be significantly improved compared to preoperatively. No further fixation was necessary and the patient's subcutaneous tissue was closed in normal fashion.

Conclusion: The technique used in our case involves a lateral approach with a trochanteric flip osteotomy to preserve the medial femoral circumflex artery and external rotators. This is similar to the approach described by Ganz in 2001 who used a posterior approach. Following the approach, the hip is then dislocated and exposed anteriorly with full visualization of the joint with a gap of about 11 cm between the femoral head and acetabulum. Surgical dislocation allows for the removal of difficult chondromas and osteophytes around the femoral head-and-neck junction. Multiple studies support the idea of surgical dislocation as an exceptional treatment method for SC.

Keywords: Chondromatosis; Chondrometaplasia; Chondrosis; Lateral approach; Osteochondromatosis; Reichel syndrome; Surgical approach; Surgical dislocation; Synovial; Synovial chondromatosis.

Figure 1

Pre-operative imaging from clinical encounter. Anteroposterior (a), frog-leg lateral left hip (b), and anteroposterior pelvis (c) radiographic views demonstrate multiple left hip intra-articular calcifications surrounding the femoral neck. There is also noted to be left hip joint space narrowing.

Figure 2

Pre-operative MRI imaging of B/L hip.

Figure 3

Actual pathological slide demonstrating synovial chondromatosis.

Figure 4

Post-operative radiograph of the left hip at 2 weeks.