Chondrolysis of the Hip

Key Points:

  • Rapid progressive damage to the articular cartilage of the hip
  • May be primary (idiopathic) or secondary
  • Often presents with hip pain and stiffness
  • Radiographic findings of asymmetric (mostly central) diminution of joint space (less than 3mm)
  • Treatment aimed at restoration of motion

Description:

Chondrolysis is defined as rapidly progressive loss of articular cartilage from both the femoral and acetabular sides of the hip. It may be idiopathic (Jones 1971) or secondary to underlying conditions, such as Slipped Capital Femoral Epiphysis (SCFE), intra-articular penetration of SCFE pins, infection, inflammatory arthritis, prolonged immobilization, or severe trauma.

Epidemiology:

Primary or idiopathic chondrolysis was initially described in adolescent African-American females, but has since been reported in other populations as well as in males; it is now most frequently encountered in pre-adolescents. (Daluga 1989) Involvement is frequently unilateral, but may be bilateral.

Clinical Findings:

The principal presentation is hip pain and stiffness with associated limping. On physical examination, there is typically a flexion, abduction, and external rotation contracture. There may be very limited motion in the hip secondary to muscle spasm. Differential diagnosis includes infectious arthritis, juvenile idiopathic arthritis, pigmented villonodular synovitis, and rare tumors such as osteoid osteoma.

Imaging Studies:

Radiographs Chondrolysis is defined as joint space narrowing to less than 3 mm. (Korula 2005) This may not be seen early on but with serial radiographs progressive, asymmetric, and mainly central loss of joint space is noted.

Bone scans demonstrate nonspecific increased radiotracer uptake in the femoral head and acetabulum.

MRI performed early in the course of the disease frequently shows a small joint effusion, synovial enhancement, and segmental altered signal intensity within the middle third of the femoral head, best seen on coronal images. (Laor 2005) As the disease progresses, extensive edema may be seen in the femoral head and acetabulum, joint fluid increases and there is progressive diminution of the joint space. (Johnson 2003)

Etiology:

The etiology is uncertain, but the process may involve a complement-mediated immunologic mechanism.

Treatment:

Examination under anesthesia to determine the degree of fixed contractures, physical therapy and continuous use of a passive motion machine, protected weight bearing, and nonsteroidal anti-inflammatory medications have been reported methods of nonoperative management. (Segaren, 2014) Aggressive surgical release (Roy 1988) and hinged hip distraction (Thacker 2005) may be needed in recalcitrant cases. The clinical course is variable. Some hips will progress to end stage arthritis or even spontaneous fusion, whereas others may completely heal. (Bleck 1983)

Complications:

End stage arthritis, protrusio acetabuli, and spontaneous hip fusion may be seen in some cases.

References:

  1. Bleck EE. Idiopathic chondrolysis of the hip.J Bone Joint Surg Am. 1983 Dec;65(9):1266-75.
  2. Daluga DJ, Millar EA. Idiopathic chondrolysis of the hip. J Pediatr Orthop. 1989 Jul-Aug;9(4):405-11.
  3. Johnson K, Haigh SF, Ehtisham S, Ryder C, Gardner-Medwin J. Childhood idiopathic chondrolysis of the hip: MRI features. Pediatric Radiology. 2003 Mar;33(3):194-9.
  4. Jones BS. Adolescent chondrolysis of the hip joint. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde. 1971 Feb 20;45(8):196-202.
  5. Korula RJ, Jebaraj I, David KS. Idiopathic chondrolysis of the hip: medium- to long-term results. ANZ Journal of Surgery. 2005 Sep;75(9):750-3.
  6. Laor T, Crawford AH. Idiopathic chondrolysis of the hip in children: early MRI findings. AJR American Journal of Roentgenology. 2009 Feb;192(2):526-31.
  7. Roy DR, Crawford AH. Idiopathic chondrolysis of the hip: management by subtotal capsulectomy and aggressive rehabilitation.J Pediatr Orthop. 1988 Mar-Apr;8(2):203-7.
  8. Segaren N, Abdul-Jabar HB, Segaren N, Hashemi-Nejad A.  Idiopathic chondrolysis of the hip: presentation, natural history, and treatment options.  J Pediatr Orthop B. 2014;  23:112-116.
  9. Thacker MM, Feldman DS, Madan SS, Straight JJ, Scher DM. Hinged distraction of the adolescent arthritic hip. J Pediatr Orthop. 2005 Mar-Apr;25(2):178-82

Top Contributors:

M. Thacker, MD