Chondrolysis

Chondrolysis represents a process characterized by progressive destruction of articular cartilage resulting in secondary joint space narrowing and stiffness

Infection (Most common)

Trauma

Idiopathic

Following SCFE Metallic penetration of the joint. Its more severe if the pins are left in the

place after penetration, ? Initiation of autoimmune response to

cartilage following pin penetration.

It is found to be more frequent in severe slips and those treated by osteotomy or cast

Characterized by an acute form of rapidly progressive chondrolysis occurring most frequently during adolescence with isolated involvement of the hip joint, but without a demonstrable cause.

Failure of nutrition of articular cartilage due to a paucity or complete lack of production of synovial fluid.

Elevations of serum immunoglobulins and C 3 components.

Abnormal intracapsular pressure

The most accepted theory is that proposed by Golding in 1973, which postulated articular cartilage resorption to be secondary to an autoimmune response in genetically susceptible individuals

Initial stages the synovium is thickened, with large, boggy villous progections

Later synovial membrane undergoes fibrotic changes,the capsule is thickened.

The amount of functioning synovium progrssively decreased.

Lusterless cartilage with irregular thinning, fibrillation and fragmentation

In chronic stages the articular cartilage is completely destroyed

In case of SCFE-As low as 1.5 percent in patient who are treated with percutaneous pinning and

As high as 50 % in patients treated with hip spica.

Females are more commonly affected than males.

Blacks persons are affected more commonly than any other race.

Adolescent girl average of 12.5 years (idiopathic).

Insidious onset of pain in anterior or medial side of affected hip associated with joint stiffness and limp.

Patient is afebrile (in idiopathic type.)

Restriction of motion in all planes with associated muscle spasm

Contracture about the joint; most commonly, fixed flexion, abduction and external rotation

Hallmark is narrowing of the joint space from normal 3-5 mm to values <3 mm.

Associated osteopenia of the periarticular osseous structures

Irregular blurring of subchondral sclerotic lines

Enlargement of the fovea capitis femori

With time, can develop mild coxa magna and femoral neck widening and frequently a premature closure of the proximal femoral physis and trochanteric apophysis

Limited area of periosteal new bone formation along inferior femoral neck

Arthrography - help document cartilage resorption and joint space narrowing

Bone scan shows increased uptake

CT Pelvis - document subchondral bone changes, cartilage resorption, and narrowing of joint space

Tubercular synovitis

Juvenile rheumatoid arthritis: There is an extended period of time with symptoms prior to chondrolysis. Rarely see restrictions in range of motion as that seen with Idiopathic Chondrolysis.

Seronegative spondyloarthropathy: You will see additional joint involvement.

Pigmented villonodular synovitis: Has a more chronic and prolonged course. Usual findings include cystic erosions in subchondral bone and a bloody aspirate

Supportive and non specific

Look for pin penetration or e/o low grade infection.

ROM exercises and anti inflammatory drugs.

Traction, muscle releases, capsulotomy have been described for idiopathic condrolysis.

Patient who continue to have severe pain and restricted ROM, THR can be done.