Calcium Pyrophosphate Deposition Disease CPPD Chondrocalcinosis

Calcium pyrophosphate deposition disease is the crystalline arthropathy most likely to affect the hip joint.65 The cause of the disease is unknown, but pathologically it results from increased calcium or inorganic phosphate concentrations in hyaline or fibrocartilage that precipitate to form crystals. Chon-drocalcinosis is the descriptive term used to denote the presence of calcium pyrophosphate crystals in cartilage, and although it occurs in the hip it is radiographically difficult to distinguish. (Figure 14.9.) The deposition and shedding of crystals lead to the clinical syndrome of calcium pyrophosphate deposition disease (CPPD), which can result in acute and chronic synovitis. It has been postulated that chronic syn-ovitis secondary to CPPD plays a role in the initiation of hip joint degeneration and osteoarthritis.66 Menkes et al studied the frequency and significance of articular chondrocalcinosis in hip osteoarthritis. Its presence at the time of arthroplasty was found to be significantly higher in patients with rapidly destructive hip degeneration versus patients with common os-teoarthritis.11 This rapidly destructive process has also been termed a pseudorheumatoid form of CPPD,67 and reportedly affects about 5% of patients with CPPD. This form of the disease can progress from acute to chronic synovitis, with resulting rapid and diffuse hip joint destruction. This process

Figure 14.9. Joint crystals seen in a patient with chondrocalcinosis.

Figure 14.9. Joint crystals seen in a patient with chondrocalcinosis.

Chondrocalcinosis Arthroscopy

can be identified on serial plain radiographs by rapid axial narrowing and development of acetabular protrusio.

The role of hip arthroscopy in this condition is currently diagnostic, as CPPD has been encountered when patients present with acute, severe hip pain and aspiration results suggestive of infection. It has also been found in patients with longstanding, unremitting hip pain that has eluded diagnosis. It is unknown whether lavage, synovectomy, and debulking of the crystal-laden tissue will prevent or curtail articular cartilage degeneration. In patients with the pseudorheumatoid or rapidly destructive form of the disease, minimally invasive synovial debulking and lavage at an early stage may prove beneficial in slowing the rapid decimation of the hip joint.

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