Arthroscopic Surgery for Synovial Chondromatosis of the Hip: A Systematic Review of Rates and Predisposing Factors for Recurrence

Transcription

1 Arthroscopic Surgery for Synovial Chondromatosis of the Hip: A Systematic Review of Rates and Predisposing Factors for Recurrence de Sa D 1, Horner NS 2, MacDonald A 2, Simunovic N 3, Ghert MA 4, Philippon MJ 5, Ayeni OR 1. Investigation performed at McMaster University, Hamilton, ON, Canada 1 Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. 2 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. 3 Centre for Evidence-Based Orthopaedics, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. 4 Juravinski Cancer Centre, Hamilton, Ontario, Canada. 5 The Steadman Clinic, Vail, Colorado, U.S.A.

2 Funding Disclosure *No funding affiliations to be disclosed

3 Overview of Study Purpose: To quantify the recurrence rate after arthroscopy of the hip for synovial chondromatosis patients. To identify predisposing factors for recurrence after open surgery. Method: Using predetermined inclusion criteria, 3 electronic databases-embase, MEDLINE, and PUBMED-were searched. Article screening was conducted in duplicate. Reviewer agreement statistics and descriptive statistics of the included studies are presented. Results: The recurrence rate after hip arthroscopy was 7.1% (14 of 197); the rate of minor complications, such as perineal and pedal neurapraxia, was 1%. Conclusion: For synovial chondromatosis of the hip, arthroscopic removal of osteochondral fragments with synovectomy is both safe and effective, with a mean recurrence rate of 7.1%. Level of Evidence: Level IV, systematic review of Level IV studies.

4 Introduction and Background Synovial chondromatosis of the hip is usually a benign condition Characterized by metaplasia of the synovial membrane and multiple calcified nodule formation Intra-articular osteochondral fragments produced by a metaplastic synovium cause pain and functional limitations

5 Significance of Study Synovial chondromatosis causes pain and functional limitations Hip arthroscopy is used for the treatment of synovial chondromatosis Recurrence not only worsens morbidity but may lead to malignant transformation Reported recurrence rates are as high as 22% by open surgical approaches Quantification of the recurrence rate after arthroscopy and identify predisposing factors for recurrence is very important

6 Research Question This systematic review examines the available literature to address the efficacy of arthroscopic treatment of synovial chondromatosis, with respect to recurrence rates, and identifies predisposing factors for recurrence after arthroscopic hip surgery

7 Methods Literature databases searched: EMBASE, MEDLINE and PUBMED databases Databases searched for eligible studies published through to February 16, 2014 Article screening was conducted in duplicate. Reviewer agreement statistics and descriptive statistics of the included studies are presented

8 Results

9 Results Out of 2,542 studies, 14 studies satisfied the criteria for inclusion A total of 197 patients underwent hip arthroscopy for removal of intraarticular osteochondral fragments and synovectomy Age range of these patients: from 13 to 81 years Follow-up periods ranged from 1 to 184 months, with approximately 7.6% of patients (15 of 197) lost to follow-up Recurrence rate was 7.1% (14 of 197) Rate of minor complications (perineal and pedal neurapraxia) was 1%

10 Limitations This systematic review addresses the issue of recurrence in hip synovial chondromatosis after arthroscopic management Though methodologically sound, this systematic review is limited by the lack of availability of high-quality studies Further study into when and how much synovium to resect is required How to deal with post-hip arthroscopy recurrences needs further delineation

11 Conclusions Conclusion Arthroscopic removal of osteochondral fragments with synovectomy is safe and effective The mean recurrence rate is 7.1% Future Directions A prospective cohort study or case-control study be used to advance the existing quality of the literature

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