Abstract
Several conditions can lead to the development of a subchondral cyst. The mechanism by which the cysts form, their location, and their severity depend on the underlying pathology, although the exact pathogenesis is not fully elucidated. Treatment options vary according to the location of the cyst, with less invasive procedures such as calcium phosphate cement injection to a joint arthroplasty when there is an extensive cyst in communication with the joint space. If the cyst is circumscribed, an intraosseous bioplasty (IOBP) can be performed. Described in this paper is an IOBP, a minimally invasive technique that preserves the joint and can be applied to most subchondral cysts. In our patient, both the appearance of the cyst at imaging and pain after IOBP greatly improved with the combined use of decompression and grafting. In those patients in whom conservative management fails to ameliorate symptoms, IOBP should be considered.
Highlights
Subchondral cysts (SC) are common in several conditions including osteoarthritis (OA), rheumatoid arthritis (RA), osteonecrosis, and calcium pyrophosphate deposition (CPD) disease [1,2,3,4]
The cysts develop in the necrotic segment of the femoral head, whereas in CPD disease, they resemble those in the OA but are larger, and more numerous and widespread [1,3]
We describe a patient in whom intraosseous bioplasty (IOBP) was utilized, outlining clinical pearls, and indications and benefits of IOBP
Summary
Subchondral cysts (SC) are common in several conditions including osteoarthritis (OA), rheumatoid arthritis (RA), osteonecrosis, and calcium pyrophosphate deposition (CPD) disease [1,2,3,4]. Two theories—the “synovial intrusion theory” and the “bony contusion theory”—attempted to explain the formation of SC [1,8] The former suggested that a SC could be secondary to the pathology of the synovium extending into the bone from the resemblance of synovial fluid to the cystic fluid, abnormal articular cartilage over the cyst, and dislocated pieces of hyaline cartilage within the cyst [9]. This is supported by the lack of communication between the joint cavity and the subchondral cyst, the presence of the metaplastic cartilage, and the osteoclasts in the disrupted bone [10] Another proposed mechanism of cyst formation is the overloading of specific areas within the bone from the unevenness of the articular surfaces [1,11]. We describe a patient in whom IOBP was utilized, outlining clinical pearls, and indications and benefits of IOBP
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