Presentation
Persistent left hip pain, decreased range of motion, and limp. Remote childhood trauma.
Patient Data
Innumerable small, well defined, uniform calcified opacities are noted along the joint capsule of the left hip.
Multiple, mostly uniform in size, intra-articular calcific loose bodies are identified within the left hip. Small femoral head osteophytes are present. Incidental note of a 7mm benign appearing bone island in the left iliac bone. Good anatomic alignment of the lower extremity structures with preservation of the joint spaces.
Findings are most consistent with primary synovial osteochondromatosis.
Case Discussion
Primary synovial osteochondromatosis is a benign neoplasm caused by proliferation of synovial membrane and development of osseous and/or cartilaginous loose bodies. Typically, this affects males in the 3rd-5th decade of life. Often, those with primary synovial osteochondromatosis will present with a chronic, painful joint, limited range of motion, and clicking.
Generally, in the setting of monoarticular joint pain, plain film is the first modality employed, which may demonstrate multiple uniformly sized, rounded densities which vary in degree of calcification. Computed tomography and magnetic resonance imaging are capable of delineating features not readily discerned on plain film; such as proportion of chondroid vs. calcium, location of loose bodies, and occasionally may help ascertain malignant transformation.
Treatment for primary synovial osteochondromatosis is controversial. Synovectomy has shown to have a high rate of recurrence. Multiple recurrences may warrant radiation therapy.
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