An 11-year-old male patient presented with a two-year history of left hip pain, which improved with rest.
Personal history included Arnold-Chiari, Dandy Walker associated hydrocephalia, treated with ventriculoperitoneal shunt and partial seizures.
Physical examination revealed gait dysfunction with an analgesic lameness and limb adduction and lumbar hyperlordosis.
The hip presented a flexion of 20o with a flexion range of 90o, external rotation of 20o, internal rotation 10o and consolidation 20o.
Blood count, acute phase inflammation markers and rheumatologic tests yielded normal results.
The plain radiograph showed discrete regional involvement ;.
TAC, edema and disorientation of the articular cartilage with synovial hypertrophy.
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An arthrocentesis under radioscopy control was performed under general anesthesia, but no synovial fluid sample was obtained.
The study was complemented with arthrography which confirmed the existence of severe chondrolysis.
With a presumptive diagnosis of idiopathic chondrolysis, rest, discharge of the limb with the use of guns and physical rehabilitation were prescribed.
One month later a hip fracture was treated with hyaluronic acid under radioscopic control.
The evolution was torpid with persistence of symptoms despite treatment.
Ten months after diagnosis, a soft joint mobilization under general anesthesia was performed, confirming the en bloc femoral head movement with the pelvis, which was assessed as fibrous ankylosis.
Due to joint stiffness, the option to perform periarticular tenotomy was ruled out.
From the year of diagnosis the articular rigidity improved slightly so that the treatment was complemented with traction of soft parts finding a favorable response in pain control and flexure attitude.
The patient used ambulatory traction for night periods, walking with English sticks and continued with rehabilitation treatment for 6 months.
After this treatment, the attitude of flexion disappeared, being able to perform a normal life without physical activity or prolonged walking, which caused episodes of pain and limping.
Four years later, a concentric loss of 50% of the articular space was observed, with erasure of the medial line and local dissection.
The clinical evolution was favorable with disappearance of the pain and spontaneous progressive recovery almost complete of the function and mobility in a period of 6 years, as well as partial recovery of the articular space.
MRI showed joint narrowing with subchondral lesions in the femoral head and acetabulum, with no sign changes in the medulla on both sides of the joint, with a destructive process of the carti.
MRI was not previously performed due to lack of availability in the center, but it would have been more appropriate to perform a differential diagnosis.
The range of joint motion at the end of the clinical follow-up was -10o for constipation, internal rotation and external rotation with an external rotation asymmetry of 1 cm in the affected limb.
Currently, after 14 years of follow-up since the onset of symptoms, the patient lives normally, asymptomatic, Trendelenburg (-), symmetrical and painless mobility of both hips (RI 30o, RE 65o).
