Background: Both synovial chondromatosis and femoroacetabular impingement present with hip pain and may lead to hip osteoarthritis. We present a small case series and describe the clinical presentation, investigation, and treatment of patients with synovial chondromatosis who also had cam-type femoroacetabular impingement involving the same hip.
Methods: Five patients (four men and one woman with a mean age of thirty-four years [range, thirty to thirty-seven years]) with unilateral synovial chondromatosis of the hip presented with clinical and radiographic features of ipsilateral cam-type femoroacetabular impingement. The diagnosis of associated synovial chondromatosis was made on the basis of preoperative imaging in four of the cases. All patients were treated with surgical hip dislocation, excision of the synovial chondromatosis loose bodies, and reshaping of the femoral head-neck junction.
Results: These hips exhibited radiographic features that are not typically seen with idiopathic cam-type femoroacetabular impingement, including femoral head hypertrophy, lateralization of the femoral head, and haziness in the acetabular fossa. None of the hips showed signs of advanced osteoarthritis intraoperatively. The alpha angle improved from a mean of 72.4° preoperatively to 42.6° postoperatively. At a mean of twenty-two months of follow-up, the patients had a mean Harris hip score of 80.6, substantially improved from the preoperative value of 39.
Conclusions: Hips with synovial chondromatosis may present with clinical and radiographic features resembling those of cam-type femoroacetabular impingement. As simultaneous treatment of both conditions is best accomplished with surgical hip dislocation rather than other, less-extensive surgical approaches, we recommend preoperative consideration of synovial chondromatosis in patients presenting with unilateral cam-type femoroacetabular impingement.
Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Peer Review This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.
Investigation performed at Shafa Hospital, Iran University of Medical Sciences, Tehran, Iran, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.
- Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated
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