Updated: 10/12/2016

Synovial Chondromatosis

Topic
Review Topic
0
0
Questions
4
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0
Evidence
3
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https://upload.orthobullets.com/topic/8051/images/synovial_moved.jpg
Introduction
  • proliferative disease of the synovium
    • associated with cartilage metaplasia
    • results in multiple intra-articular loose bodies 
    • ranges from synovial tissue to firm nodules of cartilage
  • Epidemiology
    • demographics
      • usually affects young adults 30-50 years of age
      • 2:1 male to female ratio
    • location
      • knee is most common location
  • Genetics
    • occasional chromosome 6 abnormalities have been found
Presentation
  • Symptoms
    • slow progression of symptoms
    • pain and swelling
      • pain worse with activity
    • mechanical symptoms including stiffness
    • can occur in the bursa overlying an osteochondroma
  • Physical exam
    • decreased range of motion
    • can have warmth, erythema, or tenderness
Imaging
  • Radiographs
    • recommended views
      • standard AP/lateral of affected joint
    • findings
      • variable depending on stage of disease
      • may show stippled calcification
  • MRI
    • initially cartilage nodules are only visible on MRI
    • lobular appearance
    • in later stage, signal drop out consistent with calcification
Studies
  • Histology
    • discrete hyaline cartilage nodules in various stages of calcification and ossification
    • chondrocytes
      • mild atypia
      • binucleate cells
      • occasional mitoses
Treatment
  • Nonoperative
    • observation
      • indications
        • mild symptoms not affecting range of motion
  • Operative
    • open or arthroscopic synovectomy and loose body resection 
      • indications
        • severe symptoms affecting range of motion
      • outcomes
        • treatment is symptomatic but may help prevent degenerative joint changes
 

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Questions (4)
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(OBQ07.57) What is the preferred treatment of painful synovial chondromatosis of the hip in a young adult as seen in the radiograph in Figure A? Review Topic

QID: 718
FIGURES:
1

Conventional total hip arthroplasty

4%

(54/1370)

2

Total hip resurfacing with synovectomy

6%

(86/1370)

3

Arthroscopic removal of loose bodies

61%

(833/1370)

4

Femoral CAM lesion osteoplasty

19%

(261/1370)

5

600cGy radiation once to affected hip joint

10%

(132/1370)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ04.197) A 47-year-old man presents with right groin pain. Hip radiograph, CT, arthroscopy, and histology slide are shown in Figures A through D. Which of the following statements is true regarding this condition? Review Topic

QID: 1302
FIGURES:
1

This is a benign metaplastic process which requires wide excision due to the risk of malignant transformation

5%

(66/1203)

2

This is a benign metaplastic process which requires symptomatic treatment

75%

(907/1203)

3

This is a benign neoplastic process which requires marginal excision

13%

(162/1203)

4

This is a benign neoplastic process which requires intralesional excision and adjuvant chemotherapy

3%

(33/1203)

5

This is a malignant neoplastic process which requires hip disarticulation and coverage

2%

(29/1203)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2
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