Loose Bodies

Symptomatic loose bodies represent the clearest indication for arthroscopic intervention. The most common source is probably posttraumatic intraarticu-lar fragments.1 Synovial chondromatosis is another source that has been variously reported.2,3 The hip is the third most common site of involvement of this disease, and the diagnosis can be elusive, with at least half of the cases unrecognized before arthroscopy, according to McCarthy et al.4 Fragments may occur in association with Legg-Calve-Perthes disease due to accompanying osteochondritis dissecans, and excision of these loose articular or osteoarticular fragments may result in remarkable improvement, even in the presence of a severely misshapen femoral head.5,6 Loose bodies can lead to secondary degenerative arthritis, but sometimes loose bodies simply occur secondary to degenerative disease. In either case, the extent of degeneration may be the limiting factor in the response to arthroscopy and, with advanced deterioration, removing the loose bodies may not be of any benefit. There have also been reports of removal of foreign objects such as bullets.7-9

Removal of symptomatic loose bodies represents the clearest indication for hip arthroscopy for three reasons:

1. The diagnosis is usually easy to determine. Ra-diodense loose bodies may be apparent on plain radiographs and can be substantiated by computer ized tomography (CT). Radiolucent cartilaginous loose bodies can be better visualized by gadolinium arthrography with magnetic resonance imaging (MRA) or iodinated contrast with CT (Arthro-CT).

2. The importance of loose body removal from the hip has been well documented in the literature, largely based on the work of Epstein,10,11 who defined the poor prognosis associated with retained intraarticular fragments. In fact, without the alternative of the arthroscopic approach, arthrotomy with dislocation of the hip for adequate debridement would be required.

3. Compared with an arthrotomy, arthroscopy is significantly less invasive and offers numerous advantages. These benefits include fewer and less serious surgical complications, lower associated morbidity, no hospitalization, less postoperative pain, and quicker recovery with return to normal activities.

Three case examples highlight the merits of the ar-throscopic approach in addressing symptomatic hips with radiographic evidence of loose bodies.

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