Die Adoleszentenchondrolyse

Abstract

Chronic hip pain and stiffness can be a symptom of various diseases ranging from reactive arthritis, M. Perthes, slipped capital femoral epiphysis to septic arthritis. It may even be a first symptom of a developing rheumatic disease. Idiopathic chondrolysis of the hip is a rare but important differential diagnosis of chronic hip pain and stiffness during adolescence. Eight girls and one boy between 11 and 13 years of age, suffering from idiopathic chondrolysis of the hip were reviewed at our hospital with an average followup period of 11.4 years. The initial symptom was persistent monolateral or bilateral hip pain, associated with a limp. Within a few months all patients developed restricted hip movement, fixed flexion deformity and a pelvic tilt. Scoliosis and hyperlordosis developed subsequently. Eight patients showed an acetabular protrusion of the affected hip joint. Early X-ray features of idiopathic chondrolysis are characterised by a narrowing of the joint space and periarticular osteoporosis. During the further course, irregular demarcation of the femoral head and acetabulum, periosteal reaction with widening of the femoral neck, early epiphyseal closure, osteophyte formation and severe arthrotic changes develop. Treatment is limited to nonweight-bearing exercises and anti-inflammatory drugs, which can slow down progression of the destructive process. Five of our nine patients required total hip replacement between 7 and 13 years after disease onset. The mean age at time of surgery was 21 years.