Abstract
Persistent hip stiffness in Perthes’ disease indicates a poor prognosis and is a therapeutic
challenge. We report a case of a 13-year-old boy with a stiff Perthes’ hip that was
nonresponsive to prolonged nonsurgical treatment. Imaging revealed Catterall group
IV Perthes’ disease in an advanced reossification stage, with a focal defect in the
weight-bearing area of the capital femoral epiphysis. A focal, compressible chondral
elevation was detected on hip arthroscopy; on incision, flocculent fluid was released.
After the cyst was excised, microfracture revascularization of the chondral defect
was undertaken. Postoperatively, the patient had immediate pain relief, correction
of deformity, and restoration of painless range of motion; this has continued for
4 years since surgery was performed. Persistence of an unhealed necrotic segment in
Perthes’ disease has traditionally been associated with osteochondritis dissecans;
however, in this case, the unhealed and nonossified segment produced an elevated painful
chondral cyst that caused spasm and stiffness of the hip. Although 2 distinct types
of chondral lesions have been described in Perthes’ disease, stiffness arising because
of these lesions has not been reported. Patients with this unusual third type of chondral
lesion of the capital femoral epiphysis, which causes persistent stiffness in Perthes’
hip, may be identified and successfully treated with the use of arthroscopic techniques.
Key Words
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References
- Hip arthroscopy in the adolescent and pediatric athlete.Clin Sports Med. 2001; 20: 763-778
- Hip arthroscopy in Legg-Calve-Perthes’ disease.Arthroscopy. 1999; 15: 88-92
- Arthroscopic treatment of the sequelae of Legg-Calve-Perthes’ disease.J Bone Joint Surg Br. 1993; 75: 160
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- Osteochondritis dissecans in Legg-Calve-Perthes’ disease.J Bone Joint Surg Am. 1975; 57: 506
Article info
Publication history
Published online: November 29, 2006
Footnotes
Cite this article as: Pardiwala DN, Nagda TV. Arthroscopic chondral cyst excision in a stiff Perthes’ hip. Arthroscopy 2007;23:909.e1-909.e4 [doi:10.1016/j.arthro.2006.05.022].
Identification
Copyright
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.