Idiopathic chondrolysis of hip: a case report
Keywords:Hip, Chondrolysis, Idiopathic
Idiopathic chondrolysis of the hip is a rare condition occurring mainly in adolescents and is characterised by a rapidly progressive destruction of the articular cartilage. A male patient aged 18 years presented to us with pain in his left hip, restriction of movements, and limping due to pelvic obliquity. On examination patient had severe tenderness over left hip, fixed flexion and abduction deformity were present and all movements were painful. Radiographic imaging showed narrowing of joint space, irregular blurring of subchondral sclerotic lines and femoral neck widening. MRI scan depicts marrow changes earlier than any other imaging method. Biological markers for inflammation and infections have been studied, which was normal. To achieve mobile hip, for this patient we planned for Total hip replacement after confirming our diagnosis. Idiopathic chondrolysis of the hip is a rare clinical entity where, unfortunately, there is often a delay in diagnosis. There are characteristic clinical and radiological features but no effective therapy to arrest the disease. Until today no evidence concerning the aetiology of ICH has been presented. Therefore the treatment is mainly symptomatic. Conservative treatment focuses on pain control and preservation of joint mobility. Physiotherapy seems to be important to preserve a good range of motion. In addition most authors agree to unload the affected hip joint by means of bed rest and skin traction. Published results of surgical treatment are not conclusive and arthroplasty in young patients is controversial. There is no consensus on the treatment algorithm. Recommended surgical treatments include corrective osteotomy, bony fusion or joint arthroplasty. Awareness of the existence of this disease will lead to earlier diagnosis and management.
Waldenström H. On necrosis of the joint cartilage by epiphyseolysis capitis femoris. Acta Chir Scand. 1930;67:936-46.
del Couz Garcia A, Fernandez PL, Gonzalez MP, García AC, Gonzalez LR, Jimenez JP. Idiopathic chondrolysis of the hip: long-term evolution. J Pediatr Orthop. 1999;19:449-54.
Jones BS. Adolescent chondrolysis of the hip joint. S Afr Med J. 1971;45:196-202 .
Duncan JW, Schrantz JL, Nasca RJ. The bizarre stiff hip: possible idiopathic chondrolysis. JAMA. 1975;231:382-5.
Wenger DR, Mickelson MR, Ponseti IV. Idiopathic chondrolysis of the hip: report of two cases. J Bone Joint Surg Am. 1975;57:268-71.
Bleck EE. Idiopathic chondrolysis of the hip. J Bone Joint Surg Am. 1983;65:1266-75.
Daluga DJ, Millar EA. Idiopathic chondrolysis of the hip. J Pediatr Orthop. 1989;9:405-11.
Tal Laor, Alvin H. Crawford. Idiopathic chondrolysis of hip in children: early MRI finding. Am J Roentgenol. 2009;192:526-31.
Ippolito E, Bellocci M, Santori FS, Ghera S. Idiopathic chondrolysis of the hip: an ultrastructural study of the articular cartilage of the femoral head. Orthopedics. 1986;9:1383-7.
Rowe LJ, Ho EK. Idiopathic chondrolysis of the hip. Skeletal Radiol. 1996;25:178-82.
Korula RJ, Jebaraj I, David KS. Idiopathic chondrolysis of the hip: medium- to long-term results. ANZ J Surg. 2005;75:750-3.