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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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