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Perthes disease: This is a childhood condition (most commonly affecting children between the ages of four and eight) due to interruption in the blood supply. The outcome depends on various factors including the age of onset and the amount of the femoral head involved. In severe cases the femoral head epiphysis gets squashed leading to deformity of the femoral head which can lead to arthritis in young adults.

SUFE (slipped upper femoral epiphysis):

This is a childhood condition affecting children usually between 10 – 17 years of age (peak age is 11.5 years for girls and 13 years for boys). This is often non-traumatic. Sometimes it can present mainly as knee pain. The prognosis depends on the severity of the slip and whether the blood supply gets damaged. While deformed femoral head due to slip was previously considered to be mainly cosmetic (shortening and external rotation deformity), recent understanding of CAM type impingement suggests that this can lead to arthritis in young adults.

Dysplastic hip:

The development of the hip is abnormal with varying degrees of deformity in the hip joint. Essentially the acetabulum is shallow and steeper, resulting in point loading and shear force. In some instances the hip remains dislocated and can have a false acetabulum. Depending on the degree of the deformity, progressive arthritis can occur in young adults.

Dysplastic Hip

Hip impingement:

Recently identified condition causing hip pain in young adults.

CAM impingement:

Due to a bony bump or variation in the shape of the femoral head, the clearance of the femoral head to move in the acetabulum in flexion is limited. With repeated movement of the hip, the femoral head damages the acetabular labrum and the cartilage of the hip joint which can eventually lead to arthritis in young adults.

Cam Impingement

Pincer Impingement:

Due to over coverage of the acetabulum, the femoral neck  impinges on to the rim of the acetabulum during flexion activities damaging the acetabular labrum and eventually the articular cartilage leading to arthritis in young adults.

Pincer Impingement

Avascular necrosis of the femoral head:

Part of the femoral head dies due to loss of blood supply. This could be due to a number of reasons although in many cases the cause is unknown. Some are reversible but others can progress to collapse of the bone leading to arthritis. In the early stages, this is treated with core decompression (creating a channel for blood flow). In later stages, more invasive surgery may be required (osteotomy or hip replacement).

Avascular Necrosis

Varus deformity:

When arthritis affect the medial compartment of the knee (commonest pattern), the knee gradually becomes bowed (“bow legs”).

Mild Varus
Gross Varus

Valgus deformity:

When arthritis affect predominantly the lateral compartment of the knee (less common pattern), the knee gradually becomes bent outwards “knock knee”.

Mild Valgus
Gross Valgus

Meniscal cyst:

It is a cystic lesion usually always associated with horizontal tear of the lateral meniscus and is due to the collection of joint fluid which comes out through the meniscal tear and gets trapped by a valve like mechanism of the meniscal tear opening.  The treatment usually involves excision of the meniscal tear by arthroscopy allowing the cyst to drain back into the knee joint.

Baker’s cyst:

Also known as popliteal cyst, is usually not a true cyst and has an open communication with the knee joint. Usually associated with knee arthritis (osteoarthritis or rheumatoid arthritis). The treatment usually involves treating the primary pathology and not the cyst itself.