Loose body removal
Loose bodies are small fragments of detached bone or cartilage that float through the body, catching or locking in the joints. The best treatment and surgery for the removal of loose bodies depends on a few important factors including age, current and past health, the extent of the loose body to be removed, the location of the loose body and any history with other medications and treatments. Sports or work injuries are the most common causes of loose bodies.
Often, loose body removal is required because of degenerative diseases, such as osteoarthritis. These diseases are often found in people who use one or more of their joints an extraordinary amount, such as athletes or people whose jobs require extensive lifting, particularly overhead.
Diagnosis
A loose body can create a feeling of locking in a person’s joint. The loose particles make it difficult to move or fully extend the joint. If you have any reason to think you may have a loose body in one of your joints, or have had multiple injuries in the same area, it is important to seek medical attention. To diagnose your condition, your doctor will ask questions regarding your past and current health, as well as perform a physical exam. To determine if you need any procedures for the removal of a loose body, the following exams may be performed:
- X-ray (radiograph) – This is typically the first test performed when looking for a loose body. An X-ray is done by sending radiation through the affected joint. The bone then absorbs the radiation, which allows it to appear in a black-and-white image. Because the majority of the particles that break free have some bone or cartilage in them, they can be seen fairly clearly using this imaging technique.
- Computed tomography scan (CT or CAT scan) – A CAT scan combines X-ray and computer technology to deliver an enhanced image of the bone in the affected joint. This test provides a higher-definition image, allowing for more detail to be seen.
- Magnetic resonance imaging (MRI) – An MRI, unlike a CAT scan or X-ray, does not use radiation. Instead, you will be placed inside a vessel with electromagnetic radio waves. These waves cause vibrations, which create a resonance that can be turned into a high-definition image. This test allows the doctor to see particles that do not contain any bone and would not show up on the other imaging tests.
- Arthrography – On some occasions, arthrography may be used to see the joint in better detail. This test is performed by injecting a dye into the affected area and taking an X-ray. The dye then shows up as a contrast in the soft tissue and cartilage in the area, creating a more detailed image. CAT scans and MRIs have taken the place of this technology for imaging in some areas of the body, but this test is still used in smaller joints such as the wrist.
Nonsurgical treatment
In most instances, removal of a loose body must be done surgically. However, for less severe cases, physiotherapy and anti-inflammatory painkillers may help with symptoms and keep the joint flexible and mobile. After a loose body is treated non-surgically, you must continue to monitor your symptoms and follow up with your doctor regularly so the condition does not worsen.
Surgery
In most cases, removal of a loose body requires surgery. The aim of loose body removal surgery is to remove the cartilage or bone that has broken free during injuries and has caused the joints to be less mobile. Most loose body removal procedures are done using one of the following techniques:
- Arthroscopy – This has become the surgery of choice for many doctors. It requires only a very small incision, and so is minimally invasive, leading to fewer complications. A camera is placed through the incision to allow the doctor to see the area where he or she will work. The loose body is then removed through a suction cup that is placed inside the body through another small incision.
- Arthrotomy – For large loose bodies that cannot be removed via arthroscopy, a more extensive surgery may be needed. Instances of this are rare. This procedure uses a larger incision to get a better image inside the joint and allows the doctor to remove the loose body more easily.
Research
Research is now focused on supplements to help prevent these degenerative diseases from occurring or to slow their progression, allowing for better results from non-surgical techniques. The glucosamine supplement in particular is of interest because it is generated naturally in the fluids surrounding the joints. Therefore, it makes sense that taking supplements of this natural substance could help reduce the effects of osteoarthritis and ease pain in the joints.
Studies have shown mixed results in this regard. While many osteoarthritis sufferers have noticed significant pain relief in their joints when taking this supplement, some have not. This is likely due to the extent of the osteoarthritis. Because of this, research continues to try to determine glucosamine’s effectiveness and who should consider taking this supplement to prevent degeneration of the joints and formation of loose bodies.
As research on glucosamine and other supplements is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of joint experts at Northwell Health Orthopaedic Institute performs loose body removal surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.
