Hip arthroscopy and loose body removal

The following case is an illustration of the steps involved in hip arthroscopy and excision of loose bodies.

The patient is a 23 year old active male with locking and snapping in the left hip. He denies any history of trauma to the hip.

1.The standard anteroposterior radiograph shows some bone formation along the acetabular labrum (large arrow) as well as multiple loose bone and cartilage fragments.(small arrows).

2.Mutliple views are obtained on the MRI arthrogram. This procedure involves injection of a special material into the hip joint followed by an MRI. This gives very good detail to the cartilage as well as to the labrum. The labrum is the soft tissue structure at the edge of the hip socket. The MRI images demonstrate some early arthritis with thinning of the cartilage at the upper edge of the hip socket as well as multiple loose bone fragments in the hip. The diagnosis is established as a condition called synovial osteochondromatosis, where multiple bone and cartilage fragments proliferate within the joint. This condition is often seen in the knee.

3.Due to persistence of his pain and disability, the patient elects to undergo a hip arthroscopy and removal of the loose bodies. The procedure is performed with the assistance of a special table which allows the leg to be distracted from the hip. This permits the entry of the arthroscope and other instruments into the hip joint.

4.With the use of traction, the arthroscopic camera and instruments can be entered into the hip joint.

5.These images are obtained with the arthroscope. These provide excellent visualization of structures within the joint itself as well as allow the removal of the loose fragments with the use of very small incisions.

6.The multiple loose bodies removed from the hip joint are shown. These are composed of bone and cartilage fragments.