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Case Reports
. 2018 May-Jun;8(3):47-50.
doi: 10.13107/jocr.2250-0685.1102.

Bilateral Rapidly Destructive Osteoarthritis of the Hip: Could We be Misdiagnosing? A Case Report

Martí Bernaus-Johnson  1 , F Anglès  1   2 , A Bartra  1 , M Veloso  1 , L L Font-Vizcarra  1
Affiliations
Case Reports

Bilateral Rapidly Destructive Osteoarthritis of the Hip: Could We be Misdiagnosing? A Case Report

Martí Bernaus-Johnson et al. J Orthop Case Rep. 2018 May-Jun.

Abstract

Introduction: Rapidly destructive osteoarthritis (RDO) of the hip is characterized by rapid joint destruction with no specific underlying diagnosis. Diagnostic protocols and algorithms to rule out other possible causes of the rapid destruction of the hip have not been described. Furthermore, microbiological diagnostic procedures in the medical field have dramatically changed since RDO was first described.

Case report: We report the case of bilateral RDO in a Caucasian 84-year-old female treated with a bilateral total hip replacement and propose an etiology for this condition. This is the first case that specifically mentions obtaining cultures intraoperatively as a definitive diagnostic method. It is also a rare case as it describes a patient with the bilateral rapid destruction of the hip joints.

Conclusion: Total hip arthroplasty remains as the gold-standard for treatment of RDO due to clinical severity and radiographic findings. All current clinical guidelines do not recommend using a one stage total hip replacement in an active infected site due to high risk of early prosthetic joint infection. The evidence of an infectious etiology in all or some cases of RDO would have large-scale implications regarding diagnosis and treatment of this condition.

Keywords: Rapidly destructive osteoarthritis; hip osteoarthritis; periprosthetic joint infection.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Pre-operative anteroposterior pelvis X-ray of the patient taken at the time of scheduling for surgery. Evident signs of hip destruction are noticeable in both joints.
Figure 2
Figure 2
X-ray taken on admission, 5 months after scheduling for surgery. The patient arrived in a wheelchair being unable to ambulate without pain. Important affection of acetabulums associated to a vanishing of both femoral heads.
Figure 3
Figure 3
Immediate post-operative X-ray. Cementless total hip arthroplasty (THA) of the right hip and hybrid THA of the left hip.
Figure 4
Figure 4
Last available follow-up X-ray at 18 months post-surgery. No visible radiological signs of loosening.
See this image and copyright information in PMC

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