Bilateral idiopathic chondrolysis of the hip: a case report

MRI Features and Treatment for Idiopathic Chondrolysis of the Hip (ICH) in Children: Outcomes of a Systematic Review

BACKGROUND

The purpose of this paper was to review the MRI features and treatment for idiopathic chondrolysis of the hip (ICH) in patients aged 18 years or less.

METHODS

We included studies published in English up to August 2021. We accessed major electronic bibliographic databases on ICH that described MRI features, treatment, or both. We used the Joanna Briggs Institute (JBI) Critical appraisal checklist for case reports for Risk of bias assessment.

RESULTS

We pooled 136 hips (125 participants) from 35 studies with 11.6 ± 3.4 years mean age. We had 46, 8, and 106 hips to assess ICH's MRI, pharmacological, and operative interventions. Geometric marrow edema (GME) (P < 0.01), diffuse marrow edema (DME) (P < 0.05), diffuse cartilage loss (DCL) (P < 0.05), and joint effusion (P < 0.05), were significantly associated with time in first MRI reviews. GME (P < 0.01) and focal cartilage loss (FCL) (P < 0.01) decreased significantly between two MRI reviews at median time of 1.75 (IQR 0.93-4.25) and 12.5 (IQR 3.75-19.5) months. Diffuse cartilage loss (P < 0.01) and degenerative changes (P < 0.01) increased significantly between the two MRI reviews. Etanercept, Methotrexate, and Botulinum Neurotoxin A drugs were used by 3, 3, and 1 report to treat ICH. Capsulectomies, total hip arthroplasty, arthrodiastasis, arthrodesis, arthroscopy operations treated 45, 18, 5, 5, and 2 hips.

DISCUSSION

GME may be the most specific and early MRI feature in diagnosing ICH. GME and DME show an inverse relationship over time. So, it is with FCL and DCL. Despite reports on the efficacy of biologics, immunomodulators, and operations, early and late ICH management remains controversial due to poor quality studies.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-022-00684-7.

Idiopathic chondrolysis of hip in children: New proposal and implication for radiological staging

PURPOSE

Our objective was to evaluate the radiological appearances in different stages of idiopathic chondrolysis of hip (ICH) which will be helpful in the early diagnosis and guiding appropriate treatment for this condition to prevent progression of disease.

MATERIALS AND METHODS

We evaluated 14 patients of ICH in varying stages: Stage 1 (n = 9), Stage 2 (n = 3), Stage 3 (n = 2). Average age at presentation was 10-11 years. Plain radiograph and magnetic resonance imaging (MRI) was done in all these patients.

RESULTS

In the current study, we have attempted to stage ICH based on the radiological progression of the disease, where MRI was used as the primary tool. Stage 1 showed a wedge-shaped hyperintensity in T2 weighted (T2W) and hypointensity in T1 weighted (T1W) images involving the middle one-third of the femoral head and it is the earliest and characteristic finding in MRI. Associated findings like joint space narrowing, synovial hypertrophy with joint effusion may also be observed. Stage 2 showed acetabular edema in the affected hip in addition to the above-mentioned findings. Stage 3 showed more extensive involvement of femoral head and acetabulum, with collapse of the femoral head, degenerative changes in hip, early osteoporotic changes, and ultimately loss of joint space.

CONCLUSION

Imaging-based staging system proves very useful in the early diagnosis, staging, and assessing the prognosis of ICH.

Bilateral Idiopathic Chondrolysis of the Hip in an Adult: A Case Report and Review of the Literature

Idiopathic chondrolysis of the hip usually develops in adolescents and is a disease characterized by gradual degenerative changes of the hyaline cartilage surrounding the head of the femur. It eventually decreases the hip joint space and causes limitations in the hip joint range of motion due to pain. The authors had experienced an unusual case of bilateral idiopathic chondrolysis of the hip in an 54 year-old male; thus, we report the treatment results and literature reviews in this case report.

[Factors influencing the development of chondrolysis in children treated for slipped capital femoral epiphysis]

INTRODUCTION

Chondrolysis is an infrequent but serious complication of the treatment of slipped capital femoral epiphysis. The objective of this study was to identify factors influencing the development of chondrolysis.

PATIENTS AND METHODS

The medical records of the patients operated on between 1989 and 2009 at the Rabat Children's Hospital for treatment of slipped capital femoral epiphysis were retrospectively evaluated. The minimum follow-up was 24 months. The risk of development of chondrolysis was correlated with various parameters. Statistical analysis was performed using a logistic regression model (binary outcome).

RESULTS

A total of 140 patients were included in this study. The average age was 13 years and 4 months. The incidence of chondrolysis was 11.4% (16 patients). Chondrolysis was significantly associated with obesity (25%, P<0.001) and with a delay in the diagnosis of slipped capital femoral epiphysis exceeding 60 days (75%, P=0.01) DISCUSSION: In this series, intra-articular pin penetration is not a risk factor for chondrolysis. The association of obesity and a diagnosis delay beyond 60 days increases the risk of occurrence of chondrolysis in children operated on for slipped capital femoral epiphysis. Chondrolysis can be prevented mainly through early diagnosis of slipped capital femoral epiphysis.

Joint chondrolysis

Although the disease was first described in the hip, reports of chondrolysis in nearly all diarthrodial joints have since emerged with considerable variations in the literature.Despite speculation among clinicians and researchers about the implicit causal pathways and etiologic contributors associated with chondrolysis, definitive answers remain elusive.The term chondrolysis has been applied to varied levels of joint cartilage destruction from focal chondral defects to diffuse cartilage loss, revealing a lack of consistency in the application of diagnostic criteria to guide differential disease classification.Differentiating between the various potential etiologies associated with chondrolysis provides opportunities for the prevention of the disease.

In vivo effects of single intra-articular injection of 0.5% bupivacaine on articular cartilage

BACKGROUND

Single intra-articular injections of local anesthetics are commonly used clinically. Recent in vitro studies have demonstrated chondrotoxic effects of local anesthetics, with the greatest emphasis on bupivacaine toxicity. This in vivo study was conducted to determine whether a single intra-articular injection of 0.5% bupivacaine results in chondrocyte morbidity and rapid chondrolysis.

METHODS

Forty-eight Sprague-Dawley rats received a 100-microL injection of sterile 0.9% saline solution (negative control) into one stifle joint and 100 microL of either preservative-free 0.5% bupivacaine (experimental group) or 0.6 mg/mL monoiodoacetate (positive control) into the contralateral joint. The rats were killed at one week, four weeks, twelve weeks, or six months. Live and dead cells were quantified with use of three-dimensional confocal reconstructions of fluorescent-stained tissues at standardized locations on the distal part of the femur. Histological findings were graded with use of a modified Mankin score, and cell density was quantified with use of custom image-analysis software.

RESULTS

In the specimens injected with bupivacaine, the chondral surfaces remained intact as seen with gross and histological examination. No differences in superficial chondrocyte viability or modified Mankin scores were observed between the saline-solution and bupivacaine groups at any location or time point (p > 0.05). Quantitative histological analysis of the bupivacaine-treated knees at six months revealed an up to 50% reduction in chondrocyte density compared with that of the saline-solution-treated knees (p < or = 0.01). Monoiodoacetate injection resulted in death of up to 87% of the superficial chondrocyte cells at one week and chondrolysis at six months. Despite severe histological abnormalities by four weeks after monoiodoacetate injection, cartilage injury was not evident on gross inspection until six months.

CONCLUSIONS

This in vivo study showing reduced chondrocyte density without cartilage tissue loss six months after a single intra-articular injection of 0.5% bupivacaine suggests bupivacaine toxicity. The effects of bupivacaine were milder than those of an injection of 0.6% monoiodoacetate, which resulted in chondrolysis over the same time period.

Bilateral chondrolysis of the hip following liver transplantation

A 32-year-old woman with bilateral hip chondrolysis diagnosed 2 years following allogeneic liver transplantation is described. Severe osteoarthritis was demonstrated on physical examination, serial radiographs and magnetic resonance imaging. Only four cases of chondrolysis in solid organ recipients have been described in the literature.

Idiopathic chondrolysis of the hip

Idiopathic chondrolysis of the hip is a rare disease in which gradual necrosis of the hyaline cartilage covering the femoral head and acetabulum leads to joint space narrowing and motion restriction. Pain, motion range limitation, and radiographic joint space narrowing are the main manifestations. We report 2 cases in 15-year-old girls, one black and the other Caucasian. Unexplained pain and motion restriction in the left hip were the presenting manifestations. Narrowing of the hip joint space was noted on standard radiographs. Magnetic resonance imaging showed a joint effusion in 1 patient and unevenness of the femoral head contour in the other. Laboratory tests including microbiological studies were normal or negative. Nonspecific synovitis was found in biopsy specimens. Immobilization and traction were the main components of the treatment strategy.

Childhood idiopathic chondrolysis of the hip: MRI features

BACKGROUND

Childhood idiopathic chondrolysis of the hip (ICH) causes progressive destruction of the articular cartilage of the hip joint with associated bone remodelling. The MRI features of this disease have not previously been described.

OBJECTIVE

To document the MRI features of childhood ICH and determine which features may help distinguish ICH from other causes of hip joint destruction in the paediatric population.

MATERIALS AND METHODS

A retrospective review of the MRI examinations of children with clinically diagnosed ICH. All children had undergone synovial biopsy and/or joint aspiration with plain hip radiography to exclude causes of secondary chondrolysis.

RESULTS

Ten MRI examinations were performed on six children. Cartilage loss, small hip joint effusions, bone remodelling and significant regional muscle wasting were seen in all children. Cartilage loss was most severe in the central part of the joint. Synovial enhancement was not a constant feature of ICH. Serial imaging in three children showed disease progression.

CONCLUSIONS

MRI in ICH clearly demonstrates cartilage loss and enables delineation of bone and muscle abnormalities. It is helpful in the differential diagnosis of hip joint disease in children and may provide further information on the progression and aetiology of ICH.