Thursday, February 23, 2012

Spinal and articular Osteochondrosis

Osteochondrosis may affect the spine and various joints. Each joint has a different name to remember, but the patient I’m going to present suffered from Legg-Calvé-Perthes disease, which is usually a self-limited pediatric hip disorder, though not in our patient. He suffers at the same time of Scheuermann’s disease, which is the spinal form of osteochondrosis. The cause isn’t known. It appears to be multifactorial, leading to a failure of blood supply to the growing cartilage. Conservative and operative orthopedic therapy tries to avoid severe (degenerative) arthritis / osteoarthritis in later life.

Our patient was born in 1978 and has never been treated or diagnosed for osteochondrosis. In fact the neurologists of a neighboring hospital sent him to us for a statement as they couldn’t find a neurological reason for loss of vigor in the right thigh. He complained about pain in the right hip, which was stronger in the evening or also stronger after exercising. The last two years he sometimes couldn’t lift his leg. A herniotomy didn’t reduce the pain. No swelling of joints. Morning stiffness of 10 minutes. ESG 8 mm, CRP 4.7 mg/l.

X-ray lumbar spine

MRI thoracic spine

X-ray of both hips

The right hip-joint had to be replaced. Histology didn’t show sign for a rheumatic disease.

Summing up: necessity for hip joint replacement in a 33 year old man as a result of untreated Legg-Calvé-Perthes disease, which had lead to severe osteoarthritis.

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