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Sports Medicine

Chondromalacia

03/05/2007

Question:

My doctor just told me that I have this in both knees and my hips. He said that it will probably end up in all of my joints. I have already had one knee surgery and it did not do any good. I have a lot of other medical problems and I dont get around very well, and I stumble often. To the best of your medical knowledge will I end up in a wheelchair because of this? I have at least 4 family members with the same problems, is this related to a familiar disorder?

Answer:

I wasn't able to find a definition for "chinidromalacia", so I'm assuming you're inquiring about chondromalacia. This term simply means softening of cartilage... although this term is most often used to refer to problems involving the kneecap (patella), other joints (thumb, elbow, etc.) may also develop chondromalacia, usually as a result of injury. I'm not aware of chondromalacia "spreading" to involve other joints, nor am I aware of there being a hereditary predisposition to chondromalacia. Since the Sports Medicine Health Topic Area within the NetWellness website often receives inquiries regarding this condition, for further information about chondromalacia in addition to what's noted here, please perform a Search within this website, using the search term "chondromalacia" (27 hits at this time).

Chondromalacia does not typically involve the hip joints, but presumably could do so, as a result of an acute injury, or as the cumulative effect from repetitive "microinjuries" from malalignments or a joint deformity (such as congenital hip dysplasia). Chondromalacia involving the patella, similarly, may result from acute or repetitive microtrauma.

If knee surgery for chondromalacia is performed to removed the softened area of cartilage, this wouldn't necessarily be treating the cause if it happened to be bony malalignment or congenital deformity. Also, hip joint pain may be "referred" to the knee, in which case operating on the knee wouldn't be expected to reduce this pain. One option to sort this out would be selective injection - with Lidocaine, a "numbing medicine", usually combined with a steroid to reduce inflammation - into one or both knees, possibly followed by similar injection(s) into one or both hip joints. Malalignments and joint deformities are diagnosable by physical exam, usually supplemented by X-rays.

Your physician would be in the best position to determine your chances of "ending up in a wheelchair", but the likelihood of this would be minimized by an optimal rehabilitation program which could include - within the restrictions dictated by your other medical conditions - relevant strengthening and stretching exercises, weight loss (if appropriate), general reconditioning (such as through the use of a therapeutic - or warm water - pool), medications (anti-inflammatory medication by mouth [NSAID's], and possibly joint injection[s]), and recommendations regarding joint protection and activity modification. The expertise of a physical therapist is often invaluable in determining the best program for a particular person.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University