Chondrolysis


 
    
   

Chondrolyisis is a condition that occurs when the normal cartilage cells of a joint undergo a rapid and sudden demise. The normal layer of cartilage of the joint is quickly destroyed. Inevitably, a rapid progression to severe arthritis develops. Treatment of chondrolysis depends on the cause of the cartilage destruction as well as the joint involved. In general, there is no way to reverse the damage done by chondrolysis.

Chondrolysis has been seen in some individuals who had pumps to infuse local anesthetics following surgical procedures; there is concern that these local anesthetics could be a cause of chondrolysis. Local anesthetics in high doses may have toxic effects on cartilage cells, and may contribute to rare cases of chondrolysis.

Idiopathic chondrolysis of the hip is a rare disease in which gradual necrosis of the hyaline cartilage covering the femoral head and acetabulum leads to joint space narrowing and motion restriction. Pain, motion range limitation, and radiographic joint space narrowing are the main manifestations. We report 2 cases in 15-year-old girls, one black and the other Caucasian. Unexplained pain and motion restriction in the left hip were the presenting manifestations. Narrowing of the hip joint space was noted on standard radiographs. Magnetic resonance imaging showed a joint effusion in 1 patient and unevenness of the femoral head contour in the other. Laboratory tests including microbiological studies were normal or negative. Nonspecific synovitis was found in biopsy specimens. Immobilization and traction were the main components of the treatment strategy.

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
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  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.
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