Synovial osteochondromatosis presenting as a mass in the buttock

Arthroscopic surgery for synovial chondromatosis of the hip: a systematic review of rates and predisposing factors for recurrence

PURPOSE

Synovial chondromatosis of the hip is a benign condition whereby pain and functional limitations occur due to numerous intra-articular osteochondral fragments produced by a metaplastic synovium. Recurrence not only worsens morbidity but may lead to malignant transformation. With reported recurrence rates as high as 22% by open surgical approaches and given the increasing use of hip arthroscopy for the treatment of synovial chondromatosis, we sought to quantify the recurrence rate after arthroscopy, as well as identify predisposing factors for recurrence.

METHODS

Using predetermined inclusion criteria, 3 electronic databases--Embase, Medline, and PubMed-were searched for relevant articles addressing arthroscopic surgery for synovial chondromatosis of the hip across all available dates up to and including February 16, 2014. A hand search of the reference sections of the included studies was also completed. Article screening was conducted in duplicate. Reviewer agreement statistics and descriptive statistics of the included studies are presented.

RESULTS

From an initial retrieval of 2,542 studies, 14 studies satisfied the criteria for inclusion. A total of 197 patients (age range, 13 to 81 years) underwent hip arthroscopy for removal of intra-articular osteochondral fragments and synovectomy to alleviate both mechanical symptoms and pain. Follow-up periods ranged from 1 to 184 months, with approximately 7.6% of patients (15 of 197) lost to follow-up. The recurrence rate after hip arthroscopy was 7.1% (14 of 197), and the rate of minor complications, such as perineal and pedal neurapraxia, was 1%.

CONCLUSIONS

For synovial chondromatosis of the hip, arthroscopic removal of osteochondral fragments with synovectomy is both safe and effective, with a mean recurrence rate of 7.1%.

LEVEL OF EVIDENCE

Level IV, systematic review of Level IV studies.

ARTHROSCOPIC TREATMENT OF SYNOVIAL OSTEOCHONDROMATOSIS OF THE HIP

Objective: The objective of this study is to show the results achieved in the treatment of hip osteochondromatosis by arthroscopy. Methods: Six patients submitted to hip arthroscopy for synovial osteochondromatosis have been assessed for pre- and postoperative function and pain. The time of preoperative complaint ranged from nine to 48 months, in an average of 28.2 months and the follow-up ranged from eight to 25 months (mean: 17.1 months). Mean age was 45.1 years, with four female patients (66.6%) and the right side affected in five cases (83.3%). Results: Concerning the results according to Byrd-modified Harris' criteria, the mean score evolved from 54.1 to 90.4, and the mean score on the face expressions scale for pain assessment ranged from 1.7 to 5.1. Conclusion: arthroscopy is a good alternative for hip osteochondromatosis treatment, although longer follow-up times are required to strictly stating this. The results found so far are encouraging, constituting a littleinvasive procedure allowing good recovery.