A 20-year-old male patient presented with complaints of pain in the left hip since 1 year and difficulty in walking for 6 months. There was no history of trauma, fever, weight loss, and not a known case of diabetes and hypertension. The patient was diagnosed as tuberculosis left hip in the outside hospital without any biopsy, for which he had taken anti-tubercular treatment for 9 months, and still patient was not relieved of pain and stiffness. On examination, the patient had mild tenderness over the left hip with the restriction of joint movements. He had flexion deformity of 30 , adduction and external rotation deformity of 10 and 15  respectively. Wasting of the thigh and leg was present with no true shortening. X-ray of the pelvis with both hips anteroposterior and lateral view revealed calcified nodular mass over superior, inferior part of the femoral head, and anterior part of the neck with decreased joint space (Fig. 1). Computed tomography (CT) pelvis showed multiple intra-articular loose bodies with largest measuring 3*2.2 cm with early changes of secondary osteoarthritis and no evidence of joint effusion and erosion (Fig. 2, 3). Magnetic resonance imaging (MRI) was suggestive of early arthritis with intra-articular loose bodies. There was <10% of articular erosion of postero superior part of acetabulum. As the patient was disabled with pain, stiffness especially restricted flexion and abduction and difficulty in daily routine activities, we planned for surgical excision of the loose bodies and cheilectomy of the overgrown/ossified femoral head on superior part of the femur to improve the stiffness of affected hip joint.
The patient was operated in lateral position under spinal anaesthesia using the lateral approach to the hip. Fascia lata was cut along the line of incision and retracted anteriorly to expose the anterior capsule. Arthrotomy was done using 2 cm incision over the anterior capsule and the anterior, inferior loose bodies were removed. Superior loose bodies were approached through gluteus medius and removed (Fig. 4). Capsule was closed using ethibond suture, the wound was closed in layers, and the removed loose bodies were sent for histopathological examination (Fig. 5).
Post-operative X-rays revealed the complete removal of the loose bodies (Fig. 6), the patient was started with a hip range of motion from the 2nd post-operative day. Histopathological examination was suggestive of synovial chondromatosis with no evidence of inflammation/granuloma. At present 2-year follow-up, the patient is having full hip range of motion with no difficulty squatting, sitting cross-legged and radiological examination showed no evidence of recurrence, and there is no significant progression of arthritis (Fig. 7, 8, 9). The patient is fully satisfied with the chosen treatment and participating in running and other sports.