Primary synovial osteochondromatosis of the hip: extracapsular patterns of spread.
OBJECTIVE
To identify patterns of extracapsular extension of synovial osteochondromatosis of the hip.


METHODS
Seven cases of synovial osteochondromatosis of the hip were retrospectively reviewed. Imaging performed included conventional radiography ( n=7), arthrography ( n=1), CT ( n=3) and MR imaging ( n=3). Disease extent on imaging was assessed for each patient and the presence of intra-articular effusion, capsular abnormality and osteochondral bodies recorded. The presence and distribution of extra-articular spread was also assessed and correlated with the surgical findings. In all cases diagnosis was confirmed by biopsy, with all patients undergoing tumor resection with or without synovectomy.


RESULTS
In five cases (5/7) disease extended beyond the hip capsule, while the remaining two cases (2/7) were confined to the hip joint. These findings were confirmed at surgery. Two distinct patterns of extracapsular spread were identified. The first pattern, noted in three cases, involved tumor extension along iliopsoas. The second pattern, noted in five cases, involved tumor extension along the obturator externus fat plane. In three cases both patterns were present.


CONCLUSIONS
Extra-articular spread of synovial osteochondromatosis is common. Patterns of extra-articular spread may be predictable based on involvement of recognized periarticular bursae of the hip joint. Bursal patterns of extra-articular spread include extension into the iliopsoas bursa as well as communication along the obturator externus bursa of the hip.
Department of Radiology, St. James' University Hospital, Leeds, UK.
Philip
P
Robinson
Lawrence M
LM
White
Rita
R
Kandel
Robert S
RS
Bell
Jay S
JS
Wunder
D000328:Adult; D001706:Biopsy; D015838:Chondromatosis, Synovial / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006621:Hip Joint / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016658:Psoas Muscles / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed