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FIGURE 11.10. Case 1. MRI in coronal (A) and axial (B) orientation of the right hip showing multiple chondromas around the femoral neck (arrows). No evidence of chondromas in the acetabular fossa. zo, zona orbicularis.

tablished, and traction was released. The preoperative diagnosis was immediately confirmed: The complete peripheral compartment was packed with chondromas so that visibility was significantly reduced (Figure 11.11). A second anterolateral portal was established in line with the longitudinal axis of the femoral neck. A large flexible cannula was introduced. However, because most of the chondromas were larger than 0.8 cm in diameter with a bony core, a strong forceps had to be introduced to chop up the chondromas before they could be removed and washed out (Figure 11.12). Removal of the chondromas took about 90 minutes. It was not possible to sweep with the arthroscope into the posterior area behind the femoral neck. However, as there were no sessile and attached chondromas, posterior chondromas could be mobilized and sucked into the medial and anterior areas. Complete removal was confirmed with an arthrogram under fluoroscopy. The synovium appeared thickened and inflamed (Figure 11.13).

Result

At 1-year follow-up, the patient had maintained good range of motion and pain relief. However, radiographs and an arthrogram revealed recurrence of a few chon-dromas within the peripheral compartment. As the patient was not complaining of pain or locking, arthroscopy was postponed and follow-up recommended in case of recurrence of symptoms.

Discussion

This case example illustrates how important it is to include the inspection of the peripheral compartment

FIGURE 11.12. Case 1. Removal and chopping-up of the chondro-mas with a forceps.

during HA. The first HA of the central compartment 2 years earlier did not show any evidence of loose bodies as did the second one. However, inspection of the hip joint periphery without traction was characteristic for synovial chondromatosis. From the author's experience, the accumulation of chondromas and loose bodies within the peripheral recesses is a typical finding. Most of the synovium as the source of chondro-mas is found peripheral to the labrum (with exception of the pulvinar). If the joint is not distracted, as it is

FIGURE 11.11. Case 1. Reduced visibility in the anterior and medial neck area because of multiple chondromas.

FIGURE 11.13. Case 1. Synovium status post removal of the chon-dromas, with evidence of chronic inflammation and fibrosis.

CHAPTER 11: HIP ARTHROSCOPY WITHOUT TRACTION

FIGURE 11.14. Case 2. Anteroposterior radiograph of the right hip indicating small radiodense spots medial to the transition of the femoral neck and head and in the acetabular fossa (arrows).

under nonoperative conditions, the labrum and transverse ligament seal the central compartment, keeping the chondromas in the joint periphery.

The recurrence of chondromas is a known problem that always leads to the question whether a synovec-tomy should have been performed. However, studies have shown that recurrence does not significantly differ if synovectomy was done or not.71 In addition, open or arthroscopic synovectomy of the hip joint can only be partial, at least with the current techniques. We therefore remove chondromas only.

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