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Idiopathic chondrolysis of the hip

Idiopathic chondrolysis of the hip is a rare condition characterized by the destruction of articular cartilage in the hip of unknown cause, mainly affecting adolescent females. It presents with insidious hip, thigh, or knee pain and radiographic evidence of joint space narrowing. While the etiology is unknown, theories include abnormal cartilage metabolism triggered by an environmental event, abnormal intra-articular pressure, or mechanical insult to the cartilage. Treatment focuses on NSAIDs, protected weight bearing, range of motion exercises, and in some cases surgery such as distraction arthroplasty or arthroplasty.

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IDIOPATHIC CHONDROLYSIS OF THE HIP
INTRODUCTION  Very rare  Characterized by  the destruction of articular cartilage due to an unknown cause, principally affecting women during adolescence and producing premature degeneration of hip.  Insidious onset of pain in hip, thigh, knee.  Radiographic symmetrical joint space narrrowing.  Most common cause of degenerative arthritis of hip in women.  Most commonly affects hip, but also involves knee, shoulder, annkle.
ETIOLOGY  Single hip more than double.  Right hip more than left.  Six times more common in females.  Onset most commonly around 11-12 years.  Theories for causation  Abnormal chondrocytes metabolism triggered by unknown environmental event  Abnormal intracapsular pressure  Mechanical insult to articular cartilage
PATHOLOGY  Microscopically, zone 1 is missing and zone 2 is superficial layer.  Collagen fibrils thinner, more uniform in diameter.  Degenerating chondrocytes and debris of dead cells found  But many chondrocytes are still vital, important for subsequent regeneration of the articular cartilage.  IgM and C3 deposited in synovium.
CLINICAL FEATURES  Classical case: premenstrual girl of 11-12 years with insidious onset of pain in affected hip, anterior thigh or knee  Stiffness and limp  No constitutional symptoms  If late, fixed contractures, LLD, pelvic obliquity, incresed lumbar lordosis.
LAB FINDINGS  CBC, CRP, Rh Factor, HLA B27 Ag, ANA, MT, Blood culture all negative.  ESR +/-  Important to rule out other infective and inflammatory causes of hip in volvement.
RADIOGRAPHY  Early stage: normal xcept regional osteoporosis  Later: concentric narrowing of joint space, small subchondral erosions.  A concentric diminution of the articular space of less than 3mm is considered diagnostic for idiopathic chondrolysis.  Premature closure of capital femoral physis  Lateral overgrowth of femoral head on neck.  Protrusio acetabuli
 Bone scan: marked periarticular uptake and premature efusion of epiphysis of GT  MRI: cartilage loss, small synovial effusion, bone remodelling, regional muscle wasting
NATURAL HISTORY  Very variable  Severe stiffness with fibrous ankylosis and pain, poor outcome.  Gradual improvement in ROM and joint space.
TREATMENT  TOC : NSAIDs, protected weight bearing, maintenance of ROM  bed rest and traction during acute period.  Indications for surgery not defined, includes subtotal capsulotomy, contracture and tendon releases.  Aggressive physiothrapy post-op.
CURRENTLY  Arthrodiastsis by hinged distraction.  Provide joint separation and ROM, cartilage healing permitted by decreasing mechanical load and stimulating chondrocytes nourishment through motion and even distribution of synovial fluid
LASTLY  Arthroplasty  Arthrodesis ...
Idiopathic chondrolysis of the hip
Idiopathic chondrolysis of the hip
Idiopathic chondrolysis of the hip
Idiopathic chondrolysis of the hip
Idiopathic chondrolysis of the hip
Idiopathic chondrolysis of the hip