Intra-articular loose bodies are known as a cause of pain. Hip arthroscopy is an ideal setting for the removal of loose bodies; it is minimal invasive and with high potency for removal of loose bodies. However, not all loose bodies have to be removed; moreover, not all can be treated successfully arthroscopically.
Free bodies in the hip joint can be loose or attached and can be due to a variety of different etiologies: posttraumatic fractures of the femoral head or acetabulum, synovial chondromatosis, degenerative joint disease, osteochondritis dissecans after Legg-Calve-Perthes disease, unfused secondary ossification center of the acetabulum (a.k.a. os acetabuli) calcium deposit within the labrum, and ossification of the labrum. This chapter details the properties of each source-free body in the hip joint, presents a case, and discusses the treatment.
The authors’ experience is also shared with the reader. Loose bodies were found in 12% of the cases among 728 in hip arthroscopies. The group of patients with loose bodies had higher average age, higher Tonnis arthritic grading, and larger labral tears. Moreover, pain was higher according to the visual analog scale before the surgery, however similar after.
Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy with 10-year followup. Clin Orthop Relat Res. 2009;468(3):741–6.PubMedCrossRefGoogle Scholar
Byrd JW. Hip arthroscopy for posttraumatic loose fragments in the young active adult: three case reports. Clin J Sport Med. 1996;6(2):129–33; discussion 133–124–129–133; discussion 133–124.PubMedCrossRefGoogle Scholar
Milgram JW. The classification of loose bodies in human joints. Clin Orthop Relat Res. 1977;124:282–91.PubMedGoogle Scholar
Milgram JW. The development of loose bodies in human joints. Clin Orthop Relat Res. 1977;124:292–303.PubMedGoogle Scholar
Neckers AC, Polster JM, Winalski CS, Krebs VE, Sundaram M. Comparison of MR arthrography with arthroscopy of the hip for the assessment of intra-articular loose bodies. Skeletal Radiol. 2007;36(10):963–7.PubMedCrossRefGoogle Scholar
Matsuda DK. A rare fracture, an even rarer treatment: the arthroscopic reduction and internal fixation of an isolated femoral head fracture. Arthroscopy. 2009;25(4):408–12.PubMedCrossRefGoogle Scholar
Evans KN, Providence BC. Case report: fresh-stored osteochondral allograft for treatment of osteochondritis dissecans the femoral head. Clin Orthop Relat Res. 2009;468(2):613–8.PubMedCrossRefGoogle Scholar
Matsuda DK. Hip arthroscopy for trauma: innovative techniques for a new frontier. Orthopedics Today. 2010;6:6–9.Google Scholar
Boyer T, Dorfmann H. Arthroscopy in primary synovial chondromatosis of the hip: description and outcome of treatment. J Bone Joint Surg Br. 2008;90(3):314–8.PubMedCrossRefGoogle Scholar
Domb BG, Smith TW, Botser IB. In: The learning curve in hip arthroscopy: a Prospective Analysis of Importance of Surgeon Experience. American Academy of Orthopaedic Surgeons, New-Orleans; 2010.Google Scholar
Anderson LA, Erickson JA, Severson EP, Peters CL. Sequelae of Perthes disease: treatment with surgical hip dislocation and relative femoral neck lengthening. J Pediatr Orthop. 2010;30(8):758–66.PubMedCrossRefGoogle Scholar
Siebenrock KA, Powell JN, Ganz R. Osteochondritis dissecans of the femoral head. Hip Int. 2010;20(4):489–96.PubMedGoogle Scholar
Ponseti IV. Growth and development of the acetabulum in the normal child. Anatomical, histological, and roentgenographic studies. J Bone Joint Surg Am. 1978;60(5):575–85.PubMedGoogle Scholar
Martinez AE, Li SM, Ganz R, Beck M. Os acetabuli in femoro-acetabular impingement: stress fracture or unfused secondary ossification centre of the acetabular rim? Hip Int. 2006;16(4):281–6.PubMedGoogle Scholar
Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–40.PubMedCrossRefGoogle Scholar
Singleton SB, Joshi A, Schwartz MA, Collinge CA. Arthroscopic bullet removal from the acetabulum. Arthroscopy. 2005;21(3):360–4.PubMedCrossRefGoogle Scholar
Sozen YV, Polat G, Kadioglu B, Dikici F, Ozkan K, Unay K. Arthroscopic bullet extraction from the hip in the lateral decubitus position. Hip Int. 2010;20(2):265–8.PubMedGoogle Scholar
Gupta RK, Aggarwal V. Late arthroscopic retrieval of a bullet from hip joint. Indian J Orthop. 2009;43(4):416–9.PubMedCrossRefGoogle Scholar