Operative treatment of primary synovial osteochondromatosis of the hip

BACKGROUND: Primary synovial osteochondromatosis of the hip, a rare benign condition characterized by multiple intra-articular osteochondral loose bodies and synovial hyperplasia, may result in mechanical symptoms and degenerative arthritis if untreated. The purpose of this study was to report the results of arthrotomy alone or combined with anterior dislocation of the hip to perform synovectomy and removal of loose bodies in patients with this condition. METHODS: We retrospectively reviewed a consecutive series of twenty-one patients (twenty-one hips) with primary synovial osteochondromatosis of the hip treated with open surgical débridement. On the basis of the extent of extra-articular involvement as seen on preoperative magnetic resonance imaging, eight of the twenty-one patients underwent synovectomy and removal of loose bodies following anterior dislocation of the hip and thirteen underwent the same procedure with arthrotomy alone. At a mean of 4.4 years postoperatively, the patients were assessed clinically and radiographically with special attention to disease recurrence, osteoarthritis progression, and surgical complications. RESULTS: The mean Harris hip score for the entire series of patients improved from 58 points preoperatively to 91 points at the time of the latest follow-up. Eighteen of the twenty-one patients had a good or excellent clinical result, and seventeen patients were satisfied with the result of the surgery. The clinical scores, patient satisfaction scores, and radiographic grades of osteoarthritis at the time of the latest follow-up did not differ significantly between the group treated with dislocation and the group treated without dislocation. Symptomatic disease recurred in two of the thirteen hips treated with arthrotomy alone and in none of the hips that had undergone dislocation. However, the surgical complication rate was higher in the group treated with dislocation than it was in the group treated without dislocation (p = 0.042). While patients with some signs of mild osteoarthritis at the initial procedure had a higher rate of osteoarthritis progression, severe osteoarthritis requiring arthroplasty had developed in only one patient at the time of follow-up. CONCLUSIONS: At a mean of 4.4 years postoperatively, we found that open synovectomy and removal of loose bodies for the treatment of primary synovial osteochondromatosis of the hip is a reliable procedure that can effectively relieve symptoms. Our results also indicated that synovial osteochondromatosis may recur in patients with extensive involvement who are treated with synovectomy alone without dislocation of the hip; however, surgical complications are more likely to occur in patients managed with anterior dislocation of the hip and synovectomy.     

滑膜性骨软骨瘤病3例

滑膜性骨软骨瘤病 (ｓｙｎｏｖｉａｌｏｓｔｅｏ ｃｈｏｎｄｒｏｍａｔｏｓｉｓ)是一种少见的关节瘤样病变。近 5年来我们收治了 3例滑膜性骨软骨瘤病 ,其中 2例患者行手术治疗 ,术后均经病理证实 ,效果良好。1　病例资料例 1,女 ,5 6岁。因右膝关节疼痛、时有关节交锁 3年、疼痛加重半月余入院。无外伤史。体检 :右膝关节稍肿胀 ,以髌上囊明显 ,活动膝关节时有弹响及异物感 ,伴有疼痛。Ｘ线片示 :膝关节关节囊内有多个密度增高影 ,内有游离骨化点 ,大小不等。见图 1Ａ。在硬膜外麻醉下行右膝关节游离体及大部分滑膜切除术 ,取出 0 3～ 2 …     

Is synovectomy a sure treatment procedure for synovial osteochondromatosis?

In recent literature synovectomy is recommended for treating osteochondromatosis. In the case of a 25-year-old woman with an affected knee joint, who was treated with synovectomy, the authors observed recurrence 5 years later. Ten years after the operation a severe osteoarthritis had developed. Our experience suggests that this method should not be overestimated. F. Kroh came in 1932 to the same conclusion.     

Primary synovial osteochondromatosis of a subdeltoid bursa

Primary synovial osteochondromatosis (SOC) is known to be intra-articular and wherever it is observed outside a synovial joint, it is associated with the involvement of the nearby joint. Primary SOC has not been reported to involve a subdeltoid bursa. We present a case of a 52-year-old woman having a large number of loose bodies in a large tumor in the subdeltoid bursa. The swelling was first noticed by the patient 2 years back. Plain roentgenogram revealed soft tissue swelling only with no areas of calcification. On MRI, multiple nonosseous loose bodies were visualized in the bursa deep to the deltoid muscle. A surgical excision of subdeltoid bursa was done. A biopsy confirmed it to be cartilaginous loose bodies in synovial lining sugestive of metaplastic transformation of the synovial tissue.     

Vertebral synovial osteochondromatosis with compressive myelopathy.

STUDY DESIGN: A case report of vertebral synovial osteochondromatosis with compressive myelopathy. OBJECTIVES: To describe the clinical, radiologic, and histopathologic features of vertebral facet synovial osteochondromatosis with compressive myelopathy. SUMMARY OF BACKGROUND DATA: There has been only one previously reported case of synovial osteochondromatosis affecting the vertebral facet joint and no previous report of associated compressive myelopathy. METHODS: The case history, radiology, surgical findings, and histopathology are reviewed. RESULTS: Vertebral facet synovial osteochondromatosis is a potential and readily manageable cause of spinal cord compression. CONCLUSIONS: Synovial osteochondromatosis of the vertebral facet joint should be considered as a cause of compressive myelopathy.     

Arthroscopy of the elbow for synovial chondromatosis

Two cases of arthroscopic removal of multiple loose bodies are presented. Successful results were achieved, and patients had 4-year follow-up. Both cases involved classic manifestations of synovial chondromatosis. Associated degenerative changes were present in one case; histologic examination could not confirm synovial origin of the disease. Arthroscopy for removal of symptomatic loose bodies is an excellent choice as exemplified by these two cases. Care should be taken to review histologic findings, which may help in understanding the natural history of this type of process.     

Primary synovial osteochondromatosis in the ankle: a case report

Primary synovial osteochondromatosis results from the metaplasia of synovial tissue into cartilaginous tissue. This cartilaginous tissue then undergoes calcification and ossification, producing multiple osteochondral nodules. The cause of the metaplasia is unknown. Primary synovial osteochondromatosis is relatively rare and less common than secondary synovial osteochondromatosis. The primary form of the disease arises from the articular or tendon sheath synovium, whereas the secondary form is fragmented articular cartilage within the joint space. Primary synovial osteochondromatosis most commonly occurs in people aged 30 to 40 years and is more prevalent in men. Symptoms include pain, swelling, and decreased range of motion. Because of their abundance of synovial tissue, larger joints are more likely to be affected than smaller joints. Knees are the most commonly affected joints, followed by, in no specific order, shoulders, hips, and elbows. The ankle and the joints of the hand are seldomly involved. In the early stage of the disease, only active synovitis is present, and radiographs are negative. In the late stage, loose bodies can be detected on radiographs. Grossly, these bodies are consistent with ossified nodules. Microscopically, the nodules are composed of cartilaginous material lined by synovial tissue with a central area of calcification.     

Reconstruction of the triangular fibrocartilage complex after surgery for treatment of synovial osteochondromatosis of the distal radioulnar joint

Synovial osteochondromatosis of the hand is uncommon, except for tenosynovial chondromatosis of the digits. It is even more rare in the wrist joint. A patient with synovial osteochondromatosis of the distal radioulnar joint that involved the triangular fibrocartilage complex is described. At operation, synovectomy, excision of osteochondral bodies, and removal of the entire triangular fibrocartilage complex was done. The triangular fibrocartilage complex was reconstructed using part of the extensor carpi ulnaris tendon. One year after operation, the patient had regained almost full range of motion and is without pain.     

Arthroscopy in primary synovial chondromatosis of the hip: description and outcome of treatment

Between 1985 and 2000, 120 patients underwent arthroscopic management for primary synovial chondromatosis of the hip. We report the outcome of 111 patients with a mean follow-up of 78.6 months (12 to 196). More than one arthroscopy was required in 23 patients (20.7%), and 42 patients (37.8%) went on to require open surgery. Outcomes were evaluated in greater detail in 69 patients (62.2%) treated with arthroscopy alone, of whom 51 (45.9%) required no further treatment and 18 (16.2%) required further arthroscopies. Of the 111 patients, 63 (56.7%) had excellent or good outcomes. At the most recent follow-up, 22 patients (19.8%) had undergone total hip replacement. Hip arthroscopy proved beneficial for patients diagnosed with primary synovial chondromatosis of the hip, providing good or excellent outcomes in more than half the cases.     

X线平片、CT和MRI诊断滑膜骨软骨瘤病

目的比较X线、CT和MRI对滑膜骨软骨瘤病的诊断价值。方法回顾性分析20例经手术病理证实的滑膜骨软骨瘤病患者的X线平片（n=18）、CT（n=20）和MRI（n=10）表现。结果 X线平片正确诊断15例,CT正确诊断18例,MRI正确诊断8例。X线平片、CT和MRI均能显示关节周围及关节内形态多样、大小不一、数量不等的游离体;X线平片和CT均可显示游离体的钙化;MRI可显示早期软骨游离体;CT和MRI可发现关节腔积液。结论 X线平片、CT及MRI均能诊断本病,CT和MR检查能发现X线平片不能检出的病灶和征象。     

多发性骨软骨瘤病的诊治

[目的]对多发性骨软骨瘤病进行治疗、分析,总结临床经验,提高对该病的认识。[方法]回顾分析2007年5月~2013年2月收治的12例多发性骨软骨瘤病患者的临床资料。[结果]男7例,女5例;年龄6~42岁,7例有家族史。其中10例全身多发,合并畸形包括2例前臂尺桡关节脱位,1例手指关节畸形,2例下胫腓关节畸形。瘤体大小0.6 cm×1.0 cm×1.2 cm~5cm×7.6 cm×8.5 cm。所有患者行局部肿瘤切除术,手术史:1例6次,2例4次,2例2次,7例1次;每次手术切除部位:2例5个,4例3个,6例2个。1例术后发生右腓总神经损伤,经营养神经保守治疗6个月后神经功能部分恢复,发生足下垂、内翻畸形,行肌腱转位移植后功能明显改善。术后随访时间12~60个月,3例患者术后1年复发再次行局部肿瘤切除术,年龄在6~12岁。1例术后42个月发生恶变,行截肢术。[结论]多发性骨软骨瘤病诊断容易,早期一般无明显临床症状,若影响关节功能及骨骼发育应尽早手术治疗,局部肿瘤切除术效果确切,恶变率小。     

Arthroscopy and synovial hemangioma or giant cell tumour of the knee

Summary A synovial hemangioma was localized in two knees and a xanthomateous giant cell tumour in one knee by arthroscopy. It is concluded, that synovial hemangiomas will be discovered earlier and more frequently by arthroscopy. Intraarticular hemangiomas may be operated at once, but in case of hemangiomas of intermediate type an angiography is recommended.     

表现为关节外肿块的髋关节滑膜软骨瘤病误诊1例

滑膜软骨瘤病是一种较少见的自限性关节滑膜疾病，早期诊断困难，同时伴有关节外肿块就诊者极为罕见。本院收治1例伴有髋关节外肿块的滑膜软骨瘤病，现报告如下。