1. An Unusual Presentation of Synovial Chondromatosis of Hip
Patralekh MK,Yadav VP,Sanwariya A,Kumar V, Sharma M K
Maulana Azad Medical College and Associated Hospitals
Synovial chondromatosis is an uncommon condition characterized by neoformation of cartilaginous foci in the synovial membrane of joints, bursae or tendon sheaths (Murphy et a1.1962, Sim et a1.1977). We present a case of a 28 years old female who came with complaint of chronic left hip pain for 4 years. Pain used to get increased with exertion and relieved with rest and medication. There was referred pain to left knee joint region. There was no history of fever, any other bony pain or difficulty in walking. General and systemic examinations were normal. On local examination there was mild tenderness over left anterior hip associated with slight restriction of terminal movements. Active SLR was present bilaterally. There was no distal neurovascular deficit.
Plain radiograph of pelvis with bilateral hip joint revealed erosion of the infero medial aspect of the femoral neck. MRI revealed a synovial lesion/hypertrophy encircling the femoral neck with thinning or scalloping of the neck. Blood investigations were normal. Needle biopsy was done from this site and underlying soft tissue under C-arm guidance. Report of biopsy was inconclusive. Post biopsy patient sustained trivial trauma while ambulation. Plain radiograph revealed left fracture neck femur (removal of a core of bone from the inferomedial aspect of femoral neck might have further weakened the already scalloped neck and created a stress riser effect which also might have contributed to fracture occurence).
MRI of pelvis with bilateral hip joint was done pre and post biopsy that suggested infective or inflammatory etiology. An excision biopsy with uncemented modular bipolar hemiarthroplasty/reconstruction of neck with fibular auto graft/muscle pedicle bone graft and Cannulated cancellous screws was planned. Intraoperatively multiple rice bodies were seen in the hip joint. Synovial lesion located in the inferior aspect had eroded the head and neck of the femur. Frozen section revealed synovial chondromatosis. After excision biopsy of the lesion, uncemented modular bipolar hemiarthroplasty was done. Postoperative course and follow up was uneventful. Final histopathology confirmed the diagnosis of synovial chondromatosis.
On pubmed search we could find only two such cases reported in litrature.(1,2)
The purpose of this case report is to bring out a very rare presentation of synovial chondromatosis of hip leading to pathological fracture of femoral neck.
Referen
1.. Sakellariou A, Johnstone DJ, Pringle JA Synovial chondromatosis presenting as a pathological fracture of the femoral neck in an 89-year-old woman--a case report. Acta Orthop Scand Dec;69(6):640-1.
2. Szypryt P, mining P, Preston B J, Howell C J. Synovial chon- dromatosis of the hip joint presenting as a pathological frac- ture. Br J Radiol 1986;59:
Neck eroded inferiomedially
Pathological fracture
neck femur;
Hemiarthroplasty done
microscopy-multiple nodules of hyaline cartilage within synovial membrane