Case #07 Discussion:

Identification & Indications for Exam:

Patient is a 37 year old white male who presents with chronic left hip pain that is made worse upon exertion. The pain has worsened in intensity over the last few months. The patient has a past medical history significant for Legg-Calve-Perthes disease. Legg-Calve-Perthes disease is a serious pediatric hip disorder. While the cause of the disease is unknown, it is thought to be related to avascular necrosis of the hip. The course of this disease varies among patients.

Diagnostic Options:

• X- Ray films (Look at Radiologic finding section for some of the typical plain film findings associated with Legg-Calve-Perthes disease).
• Arthrography (Good for identifying the actual size and shape of the abnormal femoral head):
  • Early Stages of Legg-Calve-Perthes disease:
    • Contrast opacification of the joint can reveal subtle flattening of the chondral surface and an increase in the width of both the femoral and acetabular cartilage.
• Later stages of Legg-Calve-Perthes disease:
  • Ossific fragmentation with a smooth cartilaginous surface.

Differential Diagnosis: Collapse and an abnormally shaped femoral head can be seen in:

1. Hypothyroidism.
2. Secondary to sickle cell anemia.
3. Avascular Necrosis (Idiopathic, Secondary to steroid use or trauma).
4. Epiphyseal and Spondyloepiphyseal dysplasias.

Radiologic Follow-up: If the patient's pain persists or worsens, new x-rays can be taken to assess for the progression of his degenerative joint disease in the left hip. In the future, the patient may need a total joint replacement.