Module 29, General Orthopaedist Level

This is a 12 year old Asian female with insidious onset of left hip pain 4 months in duration. She was afebrile on presentation. Physical examination demonstrated the Left hip with 15 degrees abduction, 10 degrees adduction, 10 degrees external rotation and 0 degrees internal rotation. There was pain in left hip on range of motion and the left lower extremity was 1.5 cm longer than the right. She had an antalgic gait. The bone scan showed increased uptake at the left hip on both sides of joint. Joint space narrowing of left hip to 2 mm was noted.

Question 29A

All laboratories tests (RA and ANA and HLAB27 were negative) were normal except the ESR at 32. This is likely Rheumatoid arthritis.

Question 29B

A hip aspirate contained 20,000 WBC (all polys). This is a low grade infection and should be treated with antibiotics.

Question 29C

Periacetabular complete capsulotomy should be considered as a treatment option for this patient.

Question 29D

The primary treatment of idiopathic chondrolysis is traction, physical therapy working on active and passive ROM but with decreased weight bearing.

Question 29E

This teenager should expect that this painful stiff hip will go on to a fibrous pseudoarthrosis.