Fact-sheet: Synovial osteochondromatosis
Updated on 09/27/2019 at 9:02 AM
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Definition
Synovial osteochondromatosis may be primary or secondary.
- Primary: monoarticular arthropathy characterized by synovial proliferation and metaplasia leading to the formation of multiple intra-articular cartilaginous or osteocartilaginous foreign bodies.
- Secondary: caused by destruction of an articular surface, secondary to severe osteoarthritis, trauma, avascular osteonecrosis, rheumatoid arthritis, neuroarthropathy, or tuberculous arthropathy.
Male > Female
Middle-aged adult
Slow progression
Knee involved in 50% of cases,
then > elbow > hip > shoulder > ankle
Most often monoarticular
>> tendon sheaths, bursaeDegeneration into chondrosarcoma is exceptional
Clinical features
Locking
Pain
Radiography
- Primary form: multiple calcified intra-articular foreign bodies, often of similar size and variable opacity, which may cause erosion of the adjacent bone and widening of the joint space
- Secondary form: intra-articular foreign bodies tend to be larger, fewer in number, and more variable in size + signs of osteoarthritis or arthritis or of the underlying cause
CT
CT arthrography:
Irregular synovium
Multiple intra-articular lacunar formations
More suggestive when the chondromas are free-floating and entirely coated by contrast
Management
Surgical indication
Extraction of all foreign bodies is performed during arthroscopic surgery
The overall prognosis is favorable but will be refined depending on the appearance of the synovium and cartilage, as well as the possibility of complete or incomplete extraction of the foreign bodies
Differential diagnosis
The main causes of intra-articular foreign bodies are:
1. Osteochondritis dissecans
2. Synovial osteochondromatosis
3. Post-traumatic
4. Severe osteoarthritis
5. Neuroarthropathy