Following SCFE Metallic penetration of the joint. Its more severe if the pins are left in the placeafter penetration, ? Initiation of autoimmune response to cartilagefollowing pin penetration.
It is found to be more frequent in severe slips andthose treated by osteotomy or cast
Characterized by an acute form of rapidlyprogressive chondrolysis occurring mostfrequently during adolescence withisolated involvement of the hip joint, butwithout a demonstrable cause.
Failure of nutrition of articular cartilage due to apaucity or complete lack of production of synovialfluid. Elevations of serum immunoglobulins and C 3components. Abnormal intracapsular pressure
The most accepted theory is thatproposed by Golding in 1973, whichpostulated articular cartilage resorption tobe secondary to an autoimmune responsein genetically susceptible individuals
Initial stages the synovium is thickened, withlarge, boggy villous progections Later synovial membrane undergoes fibroticchanges,the capsule is thickened.
The amount of functioning synovium progrssivelydecreased. Lusterless cartilage with irregular thinning,fibrillation and fragmentation In chronic stages the articular cartilage iscompletely destroyed
In case of SCFE-As low as 1.5 percent in patientwho are treated with percutaneous pinning and As high as 50 % in patients treated with hip spica.
Females are more commonly affected thanmales. Blacks persons are affected more commonly thanany other race.
Adolescent girl average of 12.5 years (idiopathic). Insidious onset of pain in anterior or medial side ofaffected hip associated with joint stiffness andlimp. Patient is afebrile (in idiopathic type.)
Restriction of motion in all planes with associatedmuscle spasm Contracture about the joint; most commonly, fixedflexion, abduction and external rotation
Hallmark is narrowing of the joint space fromnormal 3-5 mm to values <3 mm. Associated osteopenia of the periarticular osseousstructures Irregular blurring of subchondral sclerotic lines Enlargement of the fovea capitis femori
With time, can develop mild coxa magna andfemoral neck widening and frequently a prematureclosure of the proximal femoral physis andtrochanteric apophysis Limited area of periosteal new bone formationalong inferior femoral neck
Arthrography - help document cartilage resorptionand 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 anextended period of time with symptoms prior tochondrolysis. Rarely see restrictions in range ofmotion as that seen with Idiopathic Chondrolysis.
Seronegative spondyloarthropathy: You will seeadditional joint involvement. Pigmented villonodular synovitis: Has a morechronic and prolonged course. Usual findingsinclude cystic erosions in subchondral bone and abloody 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 havebeen described for idiopathic condrolysis. Patient who continue to have severe pain andrestricted ROM, THR can be done.