Synovial Chondromatosis/Loose Bodies
Synovial chondromatosis is a disease affecting the synovium, the membrane around the inside of the hip joint.
The condition is characterized by the presence of many loose cartilage balls (chondromata), ranging from one to dozens. It can affect many different joints, but the hip is a more common location. Patients usually complain of pain which does not ease with exercise, steroid injection or ice/heat treatment. X-rays may be normal or show the small chondromata, but MRI scans typically diagnose the condition most definitively. Here you can see the loose bodies inside the hip joint and after removal via arthroscopic hip surgery (on the green towel). You can also see the painful red inflammation that they can cause.
There are 3 defined stages to this disease:
- Early: No loose bodies but active synovial disease
- Transitional: Active synovial disease, and loose bodies
- Late: Loose bodies but no synovial disease
In the disease, the thin flexible membrane of the synovium gradually forms blisters which calcify and enlarge. These nodules eventually break free and float around the joint space becoming larger. These add to the discomfort and stiffness of synovial chondromatosis, which is rare in general, and there is no known cure. Most patients suffering from this disease are nearly always (but not exclusively) male, and usually in their forties. The disease generally affects only one of the larger weight bearing joints (hip, ankle, knee) – although the elbow, and wrist can also be affected.
Treatment is frequently by means of removal of the loose bodies and of a partial or full Synovectomy (removal of the synovium). During hip arthroscopy, Dr. Hyman will typically remove these loose bodies through a tiny puncture using surgical tweezers and a vacuum suction. This process helps to treat the current condition and hopefully reduce the chance of recurrence.