A Case of Osteochondritis Dissecans of Hip Secondary to Perthes' Disease

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  • ペルテス病に続発したＯＣＤの１例

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Abstract

We recently encountered a rare case of osteochondritis dissecans (OCD) secondary to Perthes' disease. The patient was a 19-year-old male whose chief complaint was pain of the right hip joint accompanied by locking. He had a history of Perthes' disease (Catterall type 3, Herring class C). He underwent regular checkups after completion of treatment for Perthes' disease at school age. At age 12, abnormal shadow suggesting OCD was revealed by X-ray. At age about 15, he started to experience hip joint pain. Arthroscopy, carried out at age 16, disclosed degenerated cartilage everted like a flap behind the load-bearing area of the femoral head. When arthroscopy was performed again one year later because of relapse of hip joint pain, extensive cartilaginous degeneration and detachment were noted in the load-bearing area of the femoral head. The course of X-ray findings in this case suggests that healing of Perthes' disease was interrupted and the resultant nonunion of the newly formed bone led to the onset of OCD. It is also suggested that articular movements caused shear stress in the OCD-affected area, causing gradual separation and detachment from the base, eventually leading to manifestation of clinical symptoms.

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