Idiopathic Chondrolysis

8/19/2019 Idiopathic Chondrolysis

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IDIOPATHICIDIOPATHIC

CHONDROLYSISCHONDROLYSIS

Prof. Verghese ChackoProf. Verghese Chacko


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INTRODUCTIONINTRODUCTION

Pain and StiffnessPain and Stiffness

Little or No ConstitutionalLittle or No ConstitutionalSymptomsSymptoms

Diagnosis is Often ConfusingDiagnosis is Often Confusing

Treatment, Empirical Treatment, Empirical


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CHONDROLYSISCHONDROLYSIS

Is defined as Acute Cartilage Is defined as Acute Cartilage

NecrosisNecrosis

Caused byCaused by

Slipped capital femoral epipysisSlipped capital femoral epipysis

Pertes! diseasePertes! disease

Idiopatic Idiopatic


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CHONDROLYSIS IN SLIPPEDCHONDROLYSIS IN SLIPPED

EPIPHYSISEPIPHYSIS

INCIDENCE "" #$"%&' INCIDENCE "" #$"%&'

(O)E CO((ON A*TE) AC+TE ON(O)E CO((ON A*TE) AC+TE ON

C)ONIC O) C)ONIC SLIP C)ONIC O) C)ONIC SLIP


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CHONDROLYSIS IN PERTHES’

DISEASE

(ore in Late Onset Pertes! Disease(ore in Late Onset Pertes! Disease

An-ylosing type An-ylosing type

Stiffness And inge AbductionStiffness And inge Abduction


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IDIOPATHIC CHONDROLYSISIDIOPATHIC CHONDROLYSIS

istory istory

o .ones / 0120, coined te term .ones / 0120, coined te term

o Immuno"patologic process Immuno"patologic process

o 3o4lo5stli " metabolic disorder of3o4lo5stli " metabolic disorder of

condrocytes condrocytes


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INCIDENCE & EPIDEMIOLOGYINCIDENCE & EPIDEMIOLOGY

E6act Incidence is Not 3no5nE6act Incidence is Not 3no5n

Commonly Seen in Adolescent *emaleCommonly Seen in Adolescent *emale

A7erage Age 008$ years A7erage Age 008$ years

+sually +nilateral +sually +nilateral


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CLINICAL FEATURESCLINICAL FEATURES

SymptomsSymptoms– PainPain

– Progressi7e stiffnessProgressi7e stiffness

SignsSigns

–“fi6ed fle6ion, abduction ande6ternal rotation deformity 9

–a7erage sortening of &8$cm


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CLINICAL FEATURESCLINICAL FEATURES

– Signs :Contd;88<

– =under anaestesia te range of

mo7ement is almost fully restored but

again comes bac- to te pre7ious state

after sometime9


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NATURAL HISTORYNATURAL HISTORY

Acute Stage :> / 0> monts<

– inflammatory response in te ?oint

– loss of articular cartilage

– painful ip 5it decreasing range ofmo7ement .


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NATURAL HISTORYNATURAL HISTORY

Cronic Stage :@ / $ years<

–Painful and malpositioned an-ylosis

–Painless an-ylosis, Limitation of*unction

–Complete reco7ery bot functionallyand radiologically8


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HAEMATOLOGYHAEMATOLOGY

aemogram,

)eumatoid *actor,

Coomb!s Test,

Serum Electroporesis,

Anti"nuclear Antibody Etc8

;;8are normal8


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IMMUNOLOGYIMMUNOLOGY

Ele7ated Ig And Ig( Le7elsEle7ated Ig And Ig( Le7els

Normal IgANormal IgA


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HISTOPATHOLOGYHISTOPATHOLOGY

ross

ypertropied Syno7ium

Tin And *ragmented Cartilage


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HISTOPATHOLOGYHISTOPATHOLOGY

istology istology

*ibrillation of Articular Cartilage*ibrillation of Articular CartilageBit Condrocyte DegenerationBit Condrocyte Degeneration

Non"specific Inflammation ofSynoium


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RADIOLOGYRADIOLOGY

+niform Narro5ing Of .oint Space "@mm :Diagnostic<

Osteopenia, Protrusio Acetabuli,

Premature *usion Of Epipysis


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TREATMENTTREATMENT

Conser7ati7e– Traction :eiter s-in or s-eletal<

– Aspirin

– )ange of motion e6ercises

– (anipulation under anaestesia

== Immobilisation in a ip spica is contra" Immobilisation in a ip spica is contra"

indicated indicated ==


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TREATMENTTREATMENT

Operati7e – Soft tissue release operation /Soft tissue release operation /

anging ip!8anging ip!8

– Capsulectomy Capsulectomy

– Sub" trocanteric osteotomy toSub" trocanteric osteotomy to

correct deformity in a se7ere stiff ip8correct deformity in a se7ere stiff ip8

– Artrodesis Artrodesis

– Artroplasty" e6cision or replacement Artroplasty" e6cision or replacementartroplasty depending on te age8artroplasty depending on te age8

– Distraction artrolysis8Distraction artrolysis8


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CONCLUSIONCONCLUSION

“ “ As of now, the exact As of now, the exact

incidence and aetiologyincidence and aetiology

of these peculiarof these peculiar

conditions is not wellconditions is not wellestablished. We areestablished. We are

groping in the dark,groping in the dark,


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Idiopathic Chondrolysis