IDEOPATHIC CHONDROLYSIS

DEFINITION

• Rare disorder principally affecting hip joint of adolescent females in which the articular cartilage is destroyed producing insidious onset of pain in hip thigh or knee

• Jones in 1971

ETIOLOGY

• SINGLE HIP IS MORE COMMON• RIGHT >LEFT• 6 TIMES MORE COMMON IN FEMALES• 11-12 YERS• Abnormal metabolism in chondrocytes triggered

by unknown environmental event• Abnormal intracapsular pressure&mechanical

insult to cartilage releasing chondrolytic enzymes

PATHOLOGY

• ARTICULAR CARTILAGE FROM CORE BIOPSY OF HEAD OF FEMUR

• ZONE 1 IS MISSING,THINNER COLLAGEN FIBRILS

• DEGENERATING CHONDROCYTE,DEBRIS OF DEAD CELLS,WITH SOME STILL VITAL CHONDROCYTES

• IgM AND C3 COMPONENTS IN SYNOVIUM

CLINICAL FEATURES

• PREMENSTRUAL GIRL OF11-12YRS• INSIDIOUS ONSET OF PAIN HIP ANTERIOR

THIGH OR KNEE• STIFFNESS AND LIMPING• NO CONSTITUTIONAL SYMPTOMS• FABER,LIMB LENGTH DISCREPANCY,PELVIC

OBLIQUITY AND INCREASED LUMBAR LORDOSIS,FIBROUS ANKYLOSIS

LAB REPORTS

• R/O INFECTIVE & INFLAMMATORY CAUSES OF HIP INVOLVEMENT

• RADIOLOGY:-• REGIONAL OSTEOPOROSIS• LATER SHOWS CONCENTRIC NARROWING OF JOINT

SPACE(<3mm is diagnostic),SMALL SUBCHONDRAL BONE EROSIONS

• Premature clossure of capital femoral physis&lateral overgrowth of femoral head on neck

• Protrusioacetabulae in 50./.

Investigations contd….

• Bone scan:-• Marked Periarticular uptake• Premature fusion ofepiphysis of greater

trochanter• Precedes other imaging methodes in showing

progression,remodelig status,early involvment of opposite joint

Investigations contd…

• MRI:-• Cartilage loss• Small synovial effusion• Bone remodelling• Regional muscle wasting

Natural history

• Variable• In original paper Common outcome is poor

with fibrous ankylosis• Recently reasonably good prognosis• After acute stage is overgradual improvement

in range of movements and joint space.• Flexion extension is improved better than

abduction adduction

treatment

• Antinflammatory drugs to control synovial inflammation

• Protected weight bearing ,maitenance of range of movements

• Bed rest,traction during acute exacerbration• Surgical management-subtotal

capsulectomy,contracture and tendon releases physiotherapy

treatment

• Arthrodiastasis by hinged distraction:-• Provides joint separation and motion• Cartilage healing by decreased mechanical

load,motion and even distribution of synovial fluid providing nourishment