Idiopathic chondrolysis of the hip

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 the hip: presentation, natural history and treatment options

Idiopathic chondrolysis of the hip is a rare disorder characterized by pain, stiffness, limp and radiological loss of joint space of the affected hip. The clinical outcome varies from complete recovery to fibrous ankylosis. Management remains controversial. We aim to outline the natural history and pathology of the disease and treatment strategies.

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.

Chondrolysis of the Glenohumeral Joint After Arthroscopy: Findings on Radiography and Low-Field-Strength MRI

OBJECTIVE

The purpose of this report is to describe the clinical and imaging findings of chondrolysis of the glenohumeral joint.

CONCLUSION

In the appropriate clinical setting, both radiographs and MR images of the shoulder can be used to establish the diagnosis of chondrolysis of the glenohumeral joint.

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.

Bilateral idiopathic chondrolysis of the hip: a case report

A case of bilateral idiopathic chondrolysis of the hip is presented. Chondrolysis is a process characterized by progressive necrosis of the hyaline cartilage of the acetabulum and femoral head, resulting in secondary joint space narrowing and stiffness. A 14-year-old boy was followed during a 2-year period, and the diagnostic values of the different imaging methods (radiography, magnetic resonance imaging [MRI], and bone scintigraphy) were evaluated. Scintigraphic evidence of marked periarticular uptake and premature fusion of the epiphysis of the greater trochanter was a reliable indicator of chondrolysis. Furthermore, the bone scan could precede other imaging methods (radiography and MRI) in the diagnosis of the progression of the pathologic process, status of the remodeling activity, and early involvement of an opposite joint. Given the high sensitivity of bone scans and the high specificity of radiographic and MRI examinations in the diagnosis of acute chondrolysis of the hip, all three methods are valuable and should be used as complementary diagnostic tools.

Idiopathic chondrolysis of the hip: long-term evolution

Idiopathic chondrolysis of the hip is characterized by the destruction of the articular cartilage due to an unknown cause, principally affecting women during adolescence and producing premature degeneration of the hip. Twelve cases (11 patients) were reviewed at our hospital, with an average follow-up period of 13.2 years, during which a clinical and radiologic study was performed. Despite the treatment implemented, idiopathic chondrolysis of the hip causes progressive degeneration of the joint with the appearance of almost constant pain, stiffness, and anomalous positions. Radiologic studies show concentric narrowing of the articular space, decrease in the width of the femoral head and neck, and shortening of the affected member due to alteration in the growth physis of the upper extremity of the femur.