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Idiopathic Chondrolysis

Idiopathic chondrolysis
Objectives
  1. Define idiopathic chondrolysis
  2. Describe clinical symptoms, age of onset, and physical findings suggestive of idiopathic chondrolysis
  3. Describe the radiographic features of idiopathic chondrolysis
  4. Describe treatment for idiopathic chondrolysis, and results of treatment
  5. Discuss theories of etiology of idiopathic chondrolysis

Discussion point
  1. Is idiopathic chondrolysis the same entity as chondrolysis complicating SCFE? Why or why not?

Discussion
Idiopathic chondrolysis is well defined clinically; usually having its onset early in the second decade of life, with a marked female preponderance. Anterior hip pain is the usual initial symptom, followed by stiffness and pain with movement. An autoimmune etiology has been proposed, but confirmatory evidence is still lacking. There is more information available on chondrolysis following SCFE, it is still speculative whether idiopathic chondrolysis and chondrolysis complicating SCFE are the same entity. One paper concluded idiopathic chondrolysis could be a manifestation of pauciarticular juvenile arthritis. Laboratory values are normal. The radiographic findings are characteristic. Osteopenia is progressive with concentric narrowing of the joint space. Protrusio acetabuli is common, as is premature physeal closure. The head remains spherical, but develops osteoarthritic changes. Pathologically, the joint capsule thickens with nonspecific low grade inflammatory changes. Several small series, the largest including 14 patients have been reported. Improvement has been reported following partial capsulectomy followed by traction and aggressive rehabilitation, soft tissue release with anti-inflammatory agents, and arthrodiastasis with external fixation (although etiologies were diverse in this group). However, the most recent report with an average follow-up of 13 years concluded that pain relief was temporary, on long term follow-up only 2/ 11 patients were free of pain and one of them had an arthrodesis.

References
  1. Bleck EE. Idiopathic chondrolysis of the hip. Journal of Bone & Joint Surgery -American Volume 1983; 65( 9): 1266-75.
  2. Canadell J, Gonzales F, Barrios RH, Amillo S. Arthrodiastasis for stiff hips in young patients. International Orthopaedics 1993; 17(4): 254-8.
  3. Daluga DJ, Millar EA. Idiopathic chondrolysis of the hip. Journal of Pediatric Orthopedics 1989; 9( 4): 405-11.
  4. del Couz Garcia A, Fernandez PL, Gonzalez MP, Garcia AC, Gonzalez LR, Jimenez JP. Idiopathic chondrolysis of the hip: long-term evolution. Journal of Pediatric Orthopedics 1999; 19( 4): 449-54.
  5. Duncan JW, Nasca R, Schrantz J. Idiopathic chondrolysis of the hip. Journal of Bone & Joint Surgery -American Volume 1979; 61( 7): 1024-8.
  6. Herman JH, Herzig EB, Crissman JD, Dennis MV, Hess EV. Idiopathic chondrolysis--an immunopathologic study. Journal of Rheumatology 1980; 7( 5): 694-705.
  7. Roy DR, Crawford AH. Idiopathic chondrolysis of the hip: management by subtotal capsulectomy and aggressive rehabilitation. Journal of Pediatric Orthopedics 1988; 8( 2): 203-7.
  8. Sherlock DA. Acute idiopathic chondrolysis and primary acetabular protrusio may be the same disease. Journal of Bone & Joint Surgery -British Volume 1995; 77( 3): 392-5.
  9. van der Hoeven H, Keessen W, Kuis W. Idiopathic chondrolysis of the hip. A distinct clinical entity? Acta Orthopaedica Scandinavica 1989; 60( 6): 661-3.
  10. Wenger DR, Mickelson MR, Ponseti IV. Idiopathic chondrolysis of the hip. Report of two cases. Journal of Bone & Joint Surgery -American Volume 1975; 57( 2): 268-71.
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