CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
Chondrolysis
1.
2. Chondrolysis represents a process characterized
by progressive destruction of articular cartilage
resulting in secondary joint space narrowing and
stiffness
4. Following SCFE
Metallic penetration of the joint.
Its more severe if the pins are left in the place
after penetration,
? Initiation of autoimmune response to cartilage
following pin penetration.
5. It is found to be more frequent in severe slips and
those treated by osteotomy or cast
6. Characterized by an acute form of rapidly
progressive chondrolysis occurring most
frequently during adolescence with
isolated involvement of the hip joint, but
without a demonstrable cause.
7. Failure of nutrition of articular cartilage due to a
paucity or complete lack of production of synovial
fluid.
Elevations of serum immunoglobulins and C 3
components.
Abnormal intracapsular pressure
8. The most accepted theory is that
proposed by Golding in 1973, which
postulated articular cartilage resorption to
be secondary to an autoimmune response
in genetically susceptible individuals
9. Initial stages the synovium is thickened, with
large, boggy villous progections
Later synovial membrane undergoes fibrotic
changes,the capsule is thickened.
10. The amount of functioning synovium progrssively
decreased.
Lusterless cartilage with irregular thinning,
fibrillation and fragmentation
In chronic stages the articular cartilage is
completely destroyed
11. In case of SCFE-As low as 1.5 percent in patient
who are treated with percutaneous pinning and
As high as 50 % in patients treated with hip spica.
12. Females are more commonly affected than
males.
Blacks persons are affected more commonly than
any other race.
13. Adolescent girl average of 12.5 years (idiopathic).
Insidious onset of pain in anterior or medial side of
affected hip associated with joint stiffness and
limp.
Patient is afebrile (in idiopathic type.)
14. Restriction of motion in all planes with associated
muscle spasm
Contracture about the joint; most commonly, fixed
flexion, abduction and external rotation
15. Hallmark is narrowing of the joint space from
normal 3-5 mm to values <3 mm.
Associated osteopenia of the periarticular osseous
structures
Irregular blurring of subchondral sclerotic lines
Enlargement of the fovea capitis femori
16. With time, can develop mild coxa magna and
femoral neck widening and frequently a premature
closure of the proximal femoral physis and
trochanteric apophysis
Limited area of periosteal new bone formation
along inferior femoral neck
17. Arthrography - help document cartilage resorption
and joint space narrowing
Bone scan shows increased uptake
CT Pelvis - document subchondral bone changes,
cartilage resorption, and narrowing of joint space
18. Tubercular synovitis
Juvenile rheumatoid arthritis: There is an
extended period of time with symptoms prior to
chondrolysis. Rarely see restrictions in range of
motion as that seen with Idiopathic Chondrolysis.
19. Seronegative spondyloarthropathy: You will see
additional joint involvement.
Pigmented villonodular synovitis: Has a more
chronic and prolonged course. Usual findings
include cystic erosions in subchondral bone and a
bloody aspirate
20. Supportive and non specific
Look for pin penetration or e/o low grade infection.
ROM exercises and anti inflammatory drugs.
21. Traction, muscle releases, capsulotomy have
been described for idiopathic condrolysis.
Patient who continue to have severe pain and
restricted ROM, THR can be done.
