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CASE REPORT Table of Contents   
Year : 2004  |  Volume : 38  |  Issue : 2  |  Page : 128-129
Bilateral idiopathic chondrolysis of hip - A case report


Department of Orthopaedics, Medical College and SSG Hospital, Baroda, India

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How to cite this article:
Patel A M, Raj P K, Kapoor A K, Modi N M, Agarwal V R, Golwala P P. Bilateral idiopathic chondrolysis of hip - A case report. Indian J Orthop 2004;38:128-9

How to cite this URL:
Patel A M, Raj P K, Kapoor A K, Modi N M, Agarwal V R, Golwala P P. Bilateral idiopathic chondrolysis of hip - A case report. Indian J Orthop [serial online] 2004 [cited 2019 Dec 15];38:128-9. Available from: http://www.ijoonline.com/text.asp?2004/38/2/128/40928

   Introduction Top


Chondrolysis of the hip has been described as a complication of slipped capital femoral epiphysis [1],[2] . Chondrolysis has also been reported as a complication of immobilization and of trauma [3],[4] . It was only since 1971 has so called idiopathic chondrolysis of hip, not associated with slipped capital femoral epiphysis or other known factors, been reported as mainly occurring in black adolescents, uncommon in white adolescents and rare in male adolescents [1] . We present here a case of bilateral idiopathic chondrolysis of hip, which is rare and less frequently bilateral.


   Case Report Top


A 12 year old girl, studying in school presented with history of insidious onset of pain in the anterior part of the left hip. The pain was gradually increasing, was aggravated by movements, relieved by rest. She had associated limp and noticed stiffness of the hip in form of difficulty in sitting crossed legged and squatting. There was no pain in right hip. There was no history of trauma, systemic illness and she was otherwise healthy.

On examination she had fullness and tenderness in left Scarpa's region. Local temperature was normal and there were no scar or sinus. There was exaggerated lumbar lordosis. There was no tenderness on palpation in right hip. Local temperature was normal and there were no scar or sinuses. Movements of the left hip were restricted with absence of adduction and internal rotation. There was rubbery noise felt throughout the available range of movements in left hip. The other joints were normal to examination.

Haemogram and blood counts were within normal limits. RA factor, sickling test and mantoux test were negative. Serum IgG was 95.0 sero unit which was well within normal limits. Anteroposterior radiograph [Figure 1] showed pelvic obliquity due to abduction deformity on left side and markedly reduced hip joint space. The femoral capital physis showed premature fusion on both sides taking into consideration the age. The triradiate cartilage showed premature fusion on left side. Width of femoral head was equal to opposite side while joint space was reduced to 2 mm compared to 5 mm on right side. CT scan of pelvis with both hip shows reduced joint space on left side with areas of diffuse osteonecrotic foci within both the femoral heads. The femoral head on left appeared to be grasped by the border of the acetabulum.

The patient was given bilateral skeletal traction with about 2.5 kg on right side and 4 kg on left side. Patient was administered oral analgesics. Regular assessment was done. After continuing traction for two weeks the deformities were corrected and pain subsided. Intermittent assisted mobilization of both hips with continued traction was done. The patient was pain free and had reasonable good range of movements after 4 weeks. Mobilization exercises of hip were continued and she was advised cycling. Protected weight bearing was allowed after 2 months, once adequate clinical and radiological improvement was evident. She was advised to continue exercises and cycling[Figure 2].


   Discussion Top


Idiopathic chondrolysis of hip was first described by Jones in 1971 [1] . The etiology of idiopathic chondrolysis is still unknown [1],[3] . It was speculated that it was an ill defined immunological disease. Their series reported elevated serum immunoglobulins and C 3 component of complement in few patients [1] . In our patient the serum immunoglobulin was well within normal limits.

Bleck performed diagnostic biopsy of hip to establish diagnosis [1] . He concluded that the diagnosis of idiopathic chondrolysis was based on clinical signs, characteristic radiographic changes, coupled with lack of evidence of infection (normal leucocyte count). If the ESR is elevated, the diagnosis is most likely juvenile rheumatoid arthritis where it would be followed up by other joints involvement and could be infection [1],[4] .

The line of management discussed in literature is conservative. Non-steroidal anti-inflammatory drugs are very useful in relieving discomfort. The weight bearing should be limited with crutches and should be continued till the pain is relieved and range of motion improved. Weight bearing is allowed after 8-12 weeks. Non-weight bearing repetitive exercises, regular swimming in heated pool is recommended. Skin and skeletal traction are applied as necessary and surgery is tailored to individual cases for release of joint contractures [1] . There is high degree of chance of development of early osteoarthritis, so the patient is cautioned against overuse and overloading hip joint with excessive pressure (for example running, lifting weight, standing up from floor).

It is the degree of suspicion aided with X-rays and CT­scan findings which confirms the diagnosis. Diagnostic arthroscopic confirmation is also not necessary [1] .

 
   References Top

1.Bleck EE. Idiopathic chondrolysis of the hip. J Bone Joint Surg (Am). 1983 ; 65: 1266-1275.  Back to cited text no. 1    
2.Durbin FC. Treatment of slipped upper femoral epiphysis. J Bone Joint Surg (Br). 1960; 42: 289-302.  Back to cited text no. 2    
3.Sherlock DA. Acute idiopathic chondrolysis and primary acetabular protrusio may be the same disease. J Bone Joint Surg (Br). 1995; 77: 392-395.  Back to cited text no. 3    
4.Moule NJ, Golding. Idiopathic chondrolysis of hip. Clin Radiol. 1974; 25: 247-251.  Back to cited text no. 4    

Top
Correspondence Address:
A M Patel
C/o. MR Patel, F-2, C-Block, Sun Terrace Flats, Opp. Gurukul, B/h. Gala Towers, Memnagar, Ahmedabad-380052. Gujarat
India
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Source of Support: None, Conflict of Interest: None


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    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

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