Loose Bodies

Loose bodies of the hip may occur from traumatic injury or as a sequelae of hip disorders such as Legg-Perthes disease, spondyloepiphyseal dysplasia (see Fig. 7), chondrocalcinosis, or avascular necrosis. In patients who have Legg-Perthes disease, an unstable osteochondral fragment in the central portion of the femoral head may persist after the healing phase, particularly in patients who have a flattened, aspherical head. Patients may present with pain and mechanical symptoms such as catching or locking. The loose osteochondral lesions may be visible on radiographs, CT scan, or MRI. Arthroscopic excision has yielded

Fig. 7. Loose bodies associated with spondyloepiphyseal dysplasia. (A) Arthroscopic image of intra-articular loose body (arrow) held by grasper. (B) Multiple loose bodies after removal.

excellent results with minimal morbidity [9,14]. In the authors' series, loose bodies were associated with Legg-Perthes disease, spondyloepiphyseal dysplasia, and traumatic osteochondral fracture, and excision typically resulted in resolution of pain and mechanical symptoms during this period of follow-up; however, the longer-term prognosis in patients who have Legg-Perthes disease remains guarded if there is substantial asphericity of the femoral head [1,37].

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