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Joint Lavage, Synovectomy, Biopsy, and Loose Body Removal

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Hip Preservation Surgery

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Abstract

Synovial pathologies are rare and difficult to treat. Joint cavity is often filled by synovitis or chondromas and can disturb regular view of anatomical landmark. Time should be taken to expose the cavity and avoid any iatrogenic injury. A complete imaging with X-rays, arthro-CT or arthro-MRI, and injected MRI will help in diagnosis and guide hip arthroscopy procedure. Central and peripheral compartment should always be checked to make a complete assessment of joint cavity. The quality of synovectomy and ability to remove all loose bodies reduce the risk of recurrence. Access to medial recessus or posterior part of joint needs sometimes to adapt the portals. Catching chondromas needs different instruments (grasper, mega-grasper, multiple sizes of cannulas). Access to fovea is improved by curved instruments (curved curette, shaver, or radiofrequency probe). Prognosis is poor when chondral defect and chondropathy are extensive. Re-arthroscopy can be performed if there is recurrence of chondromatosis. For secondary coxarthrosis, THA is the best choice.

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Author information

Authors and Affiliations

  1. Clinique Maussins - Institut Nollet, Paris, France

    Idriss Tourabaly & Thierry Boyer

Authors
  1. Idriss Tourabaly
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  2. Thierry Boyer
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Editor information

Editors and Affiliations

  1. Hip and Sports Medicine Unit, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France

    Nicolas Bonin

  2. Hip Department (CAD), Gaetano Pini - CTO Orthopedic Institute, University of Milan, Milan, Italy

    Filippo Randelli

  3. Young Adult Hip Service, Addenbrooke’s - Cambridge University Hospital, Cambridge, UK

    Vikas Khanduja

1 Electronic Supplementary Material

Image 1.1

Medium-sized free loose bodies hide in medial recessus (JPG 10 kb)

Image 1.2

Chondromas in acetabular fovea (JPG 11 kb)

Image 1.3

Big chondromas filling peripheral joint space (JPG 13 kb)

Image 1.4

Electrocoagulation of synovitis in the peripheral compartment (JPG 6 kb)

Image 1.5

Resection of the lesion with a classical grasper (JPG 12 kb)

Image 1.6a

Dissection of a nodule with a radiofrequency probe. Electrocoagulate all the pedunculated part of the lesion and also beside the lesion which is important to avoid recurrence (JPG 15 kb)

Image 1.6b

Dissection of a nodule with a radiofrequency probe. Electrocoagulate all the pedunculated part of the lesion and also beside the lesion which is important to avoid recurrence (JPG 15 kb)

Image 1.7

Several chondromas fully filling the peripheral compartment. A mega-grasper is a useful tool for big free loose bodies (JPG 10 kb)

Image 1.8

Extraction of peripheral chondromas with half-pipe cannula (JPG 5 kb)

Image 1.9a

Multiple free chondromas waiting near the posterior acetabular rim (JPG 11 kb)

Image 1.9b

Multiple free chondromas in the fovea (JPG 4 kb)

Image 1.10

Extraction of posterior chondromas with a grasper and a posterior portal to access directly to the lesion (JPG 4 kb)

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Tourabaly, I., Boyer, T. (2020). Joint Lavage, Synovectomy, Biopsy, and Loose Body Removal. In: Bonin, N., Randelli, F., Khanduja, V. (eds) Hip Preservation Surgery . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61186-9_1

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  • DOI: https://doi.org/10.1007/978-3-662-61186-9_1

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-61185-2

  • Online ISBN: 978-3-662-61186-9

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