Rapidly destructive osteoarthritis of the hip joint: a case series

Abstract

Background: Rapidly destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population.

Methods: A series of cases from North Wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities.

Results: Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average 14 months) in 18 patients documented rapid hip destruction, involvement being unilateral in 13 cases. All patients underwent total hip arthroplasty, and osteoarthritis was confirmed at pathologic examination.

Conclusion: The authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. These cases are unsuitable for being placed on long waiting list due to technical difficulties in delayed surgery and compromised outcome following surgery.

Figure 1

Anteroposterior radiographs obtained in a 67-year-old woman with painful right hip. View obtained 3 months after pain began reveals typical osteoarthritis

Figure 2

6 months later, severe flattening of the femoral head with an eccentric depression of the lateral articular surface associated with superolateral subluxation, sclerosis, and subchondral defects. Notice the hatchet-like appearance of the femoral head.

Figure 3

Anteroposterior radiographs obtained in a 70-year-old woman with painful bilateral hips of 4 months duration.

Figure 4

3 months later reveals further worsening with prominent femoral head flattening and marked sclerosis with absence of osteophytes.

Figure 5

4 months later, severe destruction of femoral heads on both sides.