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  • Juvenile osteochondrosis of hip and pelvis

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  • 732.1 Juvenile osteochondrosis of hip and pelvis

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  • M91.1 Juvenile osteochondrosis of head of femur

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Description

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  • Impairment of blood flow to the hip resulting in destructive changes
  • Self-limiting disease of the hip

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Essentials of Diagnosis

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  • Age of onset or detection is best predictor of successful recovery

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General Considerations

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  • Four stages
    • 1. Condensation: bone stops and femoral head becomes necrotic
    • 2. Fragmentation of necrotic bone; femoral head and acetabulum become deformed; revascularization begins
    • 3. Reossification of femoral head
    • 4. Remodeling of femoral head and acetabulum

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Demographics

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  • Children aged 3 to 13 years old, especially males aged 5 to 7 years old
  • Males 3 to 5 times more likely than females
  • Usually unilateral; bilateral 10-20% of the time
  • Uncommon in African Americans

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Signs and Symptoms

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  • Pain
  • Antalgic gait
  • Trendelenburg gait
  • Referred pain to groin, thigh, knee
  • May have limited hip internal rotation, abduction, extension
  • Muscle spasm of hip flexors and adductors

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Functional Implications

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  • Difficulty with ambulation, stairs
  • Limited hip mobility
  • Antalgic gait

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Possible Contributing Causes

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  • Avascular necrosis of hip (i.e., lack of blood flow to the capital femoral epiphysis) due to
    • Injury
    • Infection
    • Vascular anomalies (congenital or acquired)
    • Thrombus
    • Synovitis

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Differential Diagnosis

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Imaging

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  • X-ray of hip to evaluate for avascular necrosis

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  • To orthopedic surgeon for
    • Anti-inflammatory medication
    • Traction
    • Orthotic prescription
      • Petrie cast2
      • Scottish-Rite brace3
      • Surgical repair including osteotomy

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  • Referred pain from hip
  • Muscle spasms of hip flexors and adductors
  • Gait deviations
  • Decreased mobility due to pain and partial weight-bearing with crutches
  • Decreased hip internal rotation, abduction, extension ROM

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  • For when patient released by physician for physical therapy after casting or surgical repair
  • Modalities to decrease pain
  • AROM and PROM of hip
  • Strengthening of hip
    • Hip abduction in standing or sidelying
    • Hip extension in standing or prone
      • Bridges
    • Sit-to-stand exercises
    • Wall squats
  • Gait training

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  • The patient will be able to
    • Increase hip AROM and PROM for internal rotation, abduction, extension
    • Increase strength of hip musculature, especially hip extensors and abductors
    • Ambulate 150 feet independently with crutches, non-weight bearing on involved leg
    • Ambulate independently without gait deviations or gait aides for 500 feet

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  • Children under 8 years of age with least involvement of femoral head have best outcomes, as bone has time to reshape
  • Children with complete involvement of femoral head have poorest outcomes, as bone may not heal ...

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