Idiopathic chondrolysis

Mary Wyers, MD

Children's Memorial Hospital

Abstract

17 year old with longstanding right hip pain

Publication Date: 2009-12-22

17 year old with longstanding right hip pain

plain films of the pelvis (images 1 & 2): Osteopenia, bilateral joint space loss, right worse than left, and small osteophyte on right proximal femur.

MRI of the pelvis: coronal and axial T2 weighted images (images 3 & 4): Marrow edema on both sides of right hip joint and in left acetabulum, bilateral joint space loss, right greater than left, and small bilateral joint effusions. Diminished muscle bulk.

Chondrolysis secondary to other causes, JIA

Chondrolysis is spontaneous, progressive and often rapid destruction of cartilage of the hips. It may be secondary to SCFE, trauma, infection or JRA, but idiopathic chondrolysis is a diagnosis of exclusion in the absence of these underlying conditions. Patients present with pain, joint stiffness, dramatic loss of range of motion, and absence of any systemic features (i.e. all lab tests normal).Chondrolysis is treated with physical therapy. Some patients go on to need joint replacements.

Radiographic findings include periarticular osteoporosis, joint space loss, subchondral irregularity, osteophytes, femoral head remodeling, and protrosio acetabuli.

MRI findings include cartilage loss and subchondral changes, joint effusion, marrow edema, muscle wasting (particularly gluteal muscles), and often there is lack of synovial enhancement (differentiates from JRA). Sometimes there is associated premature growth plate closure.

4 images