Loose Bodies

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Victor E. Krebs

Removal of intra-articular loose bodies from synovial joints has essentially become the territory for the orthopedic surgeon with experience in arthroscopic techniques. Arthroscopy has been reported for and effectively applied to the removal of loose bodies and foreign objects in the wrist, elbow, shoulder, ankle, knee, and hip. Although widespread use of the arthroscope in the hip joint has not been as prevalent as its use in other joints, the indications are becoming more clearly defined. Treatment of symptomatic loose bodies within the hip joint or in the pericapsular region is the most widely reported and accepted application for hip arthroscopy. Advancement of specialized arthroscopic and distraction equipment has made this technique a first-line consideration for patients with documented symptomatic loose bodies within or surrounding the hip capsule. Although arthrotomy remains the gold standard technique for direct visualization and removal of intra- and extra-articular objects or bodies, the morbidity associated with this procedure is significant. Exposure during hip arthrotomy is not comparable to the visualization that can be achieved through the arthroscope, unless the femoral head is dislocated and the ligamentum teres sacrificed. Arthroscopy therefore offers the least traumatic method for visualization of the hip and removing loose bodies. The procedure can be performed on an outpatient basis, has a low number of reported complications, and does not have an extended postoperative recovery period. Importantly, attempting arthroscopic removal of loose bodies does not preclude, complicate, or "burn bridges" for future procedures.

Loose bodies in the hip amenable to arthroscopic removal in most cases are a direct result of either antecedent trauma or disease. In the case of traumatic injury or dislocation of the hip joint, the diagnosis and source of the loose fragments within the joint should be apparent, or at least highly suspected. In some instances, a loose body may be a singular, isolated problem with no readily identifiable cause; a careful history may reveal a "minor injury" that was perceived as a pulled groin muscle. In this situation, low-energy occult trauma may have resulted in a chondral or bony injury and the formation of a loose body. In most situations, though, sin gular or multiple loose bodies represent the consequence of a more complex pathologic process. Diseases known to affect the hip and to present with symptomatic loose bodies include Legg-Calvé-Perthes disease, osteochondritis dissecans, avascular necrosis, synovial chondromatosis, and osteoarthri-tis. Every attempt should be made, therefore, to identify the underlying disease process and site of loose body origin prior to and during arthroscopic diagnosis and treatment.

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