Abstract
Purpose
Idiopathic chondrolysis of the hip is characterized by the loss of the articular cartilage of the hip joint with spectrum ranging from full recovery to fibrous ankylosis. Study assessed outcomes following intra-articular steroid injections, joint manipulation and traction immobilization.
Methods
Retrospective (2012–2021) review of 41 cases treated for idiopathic chondrolysis of hip, assessed pre-operatively and post-operatively (minimum 2-year follow-up) using Children’s Hospital Oakland Hip Evaluation Score (CHOHES), visual analogue scale (VAS) and range of motion measurements.
Results
Twenty-five patients (62%) achieved painless mobility, 6 (14%) had hip stiffness without pain and 10 (24%) had painful and stiff hips at final follow-up. They had a mean age of 12.49 ± 2.4 years and a mean follow-up duration of 33.15 ± 13.1 months. Range of motion improved significantly (p < 0.05). VAS improved to 3.93 ± 1.3 from 7.8 ± 0.7. CHOHES improved from 29.12 ± 9.9 to 56.37 ± 17.6.
Conclusion
Intra-articular steroid injection, manipulation and traction immobilization may effectively treat idiopathic chondrolysis of the hip by enhancing patient function and reducing the need for further surgical intervention.
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Data Availability
The data presented in this paper is available on request from the corresponding author.
References
Duncan JW, Schrantz JL, Nasca RJ (1975) The bizarre stiff hip. Possible idiopathic chondrolysis. JAMA 231(4):382–385
Jones BS (1971) Adolescent chondrolysis of the hip joint. S Afr Med J 45(8):196–202
Ippolito E, Bellocci M, Santori FS, Ghera S (1986) Idiopathic chondrolysis of the hip: an ultrastructural study of the articular cartilage of the femoral head. Orthopedics 9(10):1383–1387. https://doi.org/10.3928/0147-7447-19861001-10
Herman JH, Herzig EB, Crissman JD, Dennis MV, Hess EV (1980) Idiopathic chondrolysis–an immunopathologic study. J Rheumatol 7(5):694–705
Shore A, Macauley D, Ansell BM (1981) Idiopathic protrusio acetabuli in juveniles. Rheumatol Rehabil 20(1):1–10. https://doi.org/10.1093/rheumatology/20.1.1
Bilski P, Snela S (2006) Difficulties in treating chondrolysis and avascular necrosis of the hip in adolescent patients. Ortop Traumatol Rehabil 8(1):34–40
Sparks LT, Dall G (1982) Idiopathic chondrolysis of the hip joint in adolescents Case reports. S Afr Med J 61(23):883–886
Hughes AW (1985) Idiopathic chondrolysis of the hip: a case report and review of the literature. Ann Rheum Dis 44(4):268–272. https://doi.org/10.1136/ard.44.4.268
del Couz GA, Fernandez PL, Gonzalez MP, Garcia AC, Gonzalez LR, Jimenez JP (1999) Idiopathic chondrolysis of the hip: long-term evolution. J Pediatr Orthop 19(4):449–454. https://doi.org/10.1097/00004694-199907000-00006
Daluga DJ, Millar EA (1989) Idiopathic chondrolysis of the hip. J Pediatr Orthop 9(4):405–411
Johnson K, Haigh SF, Ehtisham S, Ryder C, Gardner-Medwin J (2003) Childhood idiopathic chondrolysis of the hip: MRI features. Pediatr Radiol 33(3):194–199. https://doi.org/10.1007/s00247-002-0853-x
Nema SK, Ramasubramani P, Austine J, Karunakaran G, Reddy VN, Reddy VM (2022) MRI features and treatment for idiopathic chondrolysis of the hip (ICH) in children: outcomes of a systematic review. Indian J Orthop 56(9):1491–1505. https://doi.org/10.1007/s43465-022-00684-7
Segaren N, Abdul-Jabar HB, Segaren N, Hashemi-Nejad A (2014) Idiopathic chondrolysis of the hip: presentation, natural history and treatment options. J Pediatr Orthop B 23(2):112–116. https://doi.org/10.1097/BPB.0000000000000019
Francois J, Mulier M (2007) Idiopathic chondrolysis of the hip: a case report. Acta Orthop Belg 73(5):653–657
Khoshhal KI, Awaad Y, Abbak AA (2014) Botulinum neurotoxin-A in idiopathic chondrolysis: a report of two cases. J Pediatr Orthop B 23(5):441–446. https://doi.org/10.1097/BPB.0000000000000076
Kampani KT, Papadopoulos DV, Tsantes AG, Batistatou A, Fylaktos A, Papageorgiou CD (2019) Idiopathic hip chondrolysis: a case report of a Caucasian HLA-B27 positive adolescent with a history of long walking. Rheumatol Int 39(4):751–755. https://doi.org/10.1007/s00296-018-04239-8
Appleyard DV, Schiller JR, Eberson CP, Ehrlich MG (2009) Idiopathic chondrolysis treated with etanercept. Orthopedics 32(3):214
Endo H, Akazawa H, Yashiro M, Yamada K, Sanki T, Tetsunaga T, Nishida K, Furumatsu T, Ozaki T (2020) Idiopathic chondrolysis of the hip treated by immunosuppressive therapy and arthroscopic intervention. Acta Med Okayama 74(1):77–81. https://doi.org/10.18926/AMO/57957
Patel A, Raj P, Kapoor A, Modi N, Agrawal V, Golwala P (2004) Bilateral idiopathic chondrolysis of hip–a case report. Indian J Orthop 38:128–129
Roy DR, Crawford AH (1988) Idiopathic chondrolysis of the hip: management by subtotal capsulectomy and aggressive rehabilitation. J Pediatr Orthop 8(2):203–207
Laubscher M, Banderker E, Pillay š, Held M, Dix-Peek S, Hoffman E (2016) Subtotal capsulectomy for idiopathic chondrolysis of the hip: a clinical, radiological and histological study. SA Orthopaedic J 15:22-28
Megremis P, Megremis O, Margariti R (2021) Case report: total hip replacement in a 12-year-old girl with protrusio acetabuli and disabling joint degeneration, secondary to femoral head idiopathic chondrolysis—six-year follow-up. SN Compr Clin Med 3. https://doi.org/10.1007/s42399-020-00697-z
Thacker MM, Feldman DS, Madan SS, Straight JJ, Scher DM (2005) Hinged distraction of the adolescent arthritic hip. J Pediatr Orthop 25(2):178–182. https://doi.org/10.1097/01.bpo.0000150811.33920.27
Canadell J, Gonzales F, Barrios RH, Amillo S (1993) Arthrodiastasis for stiff hips in young patients. Int Orthop 17(4):254–258. https://doi.org/10.1007/BF00194191
Bleck EE (1983) Idiopathic chondrolysis of the hip. J Bone Joint Surg Am 65(9):1266–1275
Donnan L, Einoder B (1996) Idiopathic chondrolysis of the hip. Aust N Z J Surg 66(8):569–571. https://doi.org/10.1111/j.1445-2197.1996.tb00817.x
Wenger DR, Mickelson MR, Ponseti IV (1975) Idiopathic chondrolysis of the hip. Report of two cases. J Bone Joint Surg Am 57(2):268–271
Freitas NRB, Pereira ND, Pessoa MS, Galvao F, Saad STO, Zanoni CT (2018) Translation, and interobserver and test-retest reliability of the Brazilian Portuguese version of Children’s Hospital Oakland Hip Evaluation Scale for patients with sickle cell disease. Hematol Transfus Cell Ther 40(3):226–232. https://doi.org/10.1016/j.htct.2018.01.006
Aguilar CM, Neumayr LD, Eggleston BE, Earles AN, Robertson SM, Jergesen HE, Stulberg BN, Vichinsky EP (2005) Clinical evaluation of avascular necrosis in patients with sickle cell disease: Children’s Hospital Oakland Hip Evaluation Scale–a modification of the Harris Hip Score. Arch Phys Med Rehabil 86(7):1369–1375. https://doi.org/10.1016/j.apmr.2005.01.008
Vinayak U, Gundawar C, Shyam A, Sancheti P, Vaidya SV, Agashe MV, Patwardhan S (2023) Labral support shelf acetabuloplasty for late presenting Perthes disease: outcomes in Indian patients. Indian J Orthop 57(11):1785–1792. https://doi.org/10.1007/s43465-023-00978-4
van der Hoeven H, Keessen W, Kuis W (1989) Idiopathic chondrolysis of the hip. A distinct clinical entity? Acta Orthop Scand 60(6):661–663. https://doi.org/10.3109/17453678909149597
Korula RJ, Jebaraj I, David KS (2005) Idiopathic chondrolysis of the hip: medium- to long-term results. ANZ J Surg 75(9):750–753. https://doi.org/10.1111/j.1445-2197.2005.03512.x
Bittersohl B, Zaps D, Bomar JD, Hosalkar HS (2011) Hip arthrodesis in the pediatric population: where do we stand? Orthop Rev (Pavia) 3(2):e13. https://doi.org/10.4081/or.2011.e13
Hosny GA, El-Deeb K, Fadel M, Laklouk M (2011) Arthrodiastasis of the hip. J Pediatr Orthop 31(2 Suppl):S229-234. https://doi.org/10.1097/BPO.0b013e318223b45a
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The authors acknowledge the help provided by Dr. Sughandh Kaparthi.
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SP: conceived the study; UV: performed the statistical analysis, interpretation of the data; SR: wrote the manuscript; AS: revised the manuscript, interpretation of the data; PKS: revised the manuscript; VB: acquisition of data.
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Patwardhan, S., Rapole, S., Vinayak, U. et al. Minimally invasive treatment for idiopathic chondrolysis of the hip: analysis of forty-one cases. International Orthopaedics (SICOT) 48, 1627–1634 (2024). https://doi.org/10.1007/s00264-024-06137-0
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DOI: https://doi.org/10.1007/s00264-024-06137-0