Chondrolysis and the stiff hip in Perthes' disease: an immunological study

The study was undertaken to determine whether immunologic mechanisms could account for hip stiffness and chondrolysis in Perthes' disease. Histologic and electron microscopic evidence of perivascular collections of plasma cells and lymphocytes in synovial tissue and the demonstration of elevated levels of circulating immunoglobulins in children with Perthes' disease suggest that immunologic processes are involved. Chondrolysis was observed only in children who were > 10 years old, with a totally avascular epiphysis in the stage of fragmentation. Because the serum immunoglobulin levels were not dependent on age, extent of epiphyseal avascularity, and the degree of hip stiffness, monitoring of these levels is unlikely to be of help in predicting chondrolysis.