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Case Reports
. 2022 Nov;12(11):23-27.
doi: 10.13107/jocr.2022.v12.i11.3400.

Total Hip Arthroplasty for Ochronosis: A Report of Three Cases

J Arul Durai Arasu  1 , A Arul Prasanna  1
Affiliations
Case Reports

Total Hip Arthroplasty for Ochronosis: A Report of Three Cases

J Arul Durai Arasu et al. J Orthop Case Rep. 2022 Nov.

Abstract

Introduction: Ochronosis is a rare metabolic disorder, characterized by accumulation of homogentisic acid in the connective tissues due to the lack of the enzyme homogentisic acid oxidase. The musculoskeletal manifestation of alkaptonuria is black pigmentation of cartilage of the knee and the hip leading to arthropathy.

Case report: In this article, we report three patients with involvement of hip, knee, and spine, but with more severe involvement of the hips. Bilateral hip arthroplasty was done in one out of the three patients.

Conclusion: Being a rare disorder and often missed, the functional outcome of hip arthroplasty in these patients is similar to primary osteoarthritis. The importance lies in correct diagnosis and anticipation of intraoperative difficulties.

Keywords: Ochronosis; alkaptonuria; arthropathy; arthroplasty; metabolic arthropathy.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Clinical image showing the black pigmentation of the sclera and the skin over the thenar and hypothenar eminences of the palm.
Figure 2
Figure 2
X-ray of the pelvis with hips showing the arthritis of the left hip joint, X-ray of the lumbar spine showing the loss of disc space with fusion of vertebrae and the CT image of the hip showing the acetabular erosion.
Figure 3
Figure 3
Intraoperative clinical picture showing the black discoloration over the greater trochanter, black pigmentation over the cartilage of femoral head, and also inside the head.
Figure 4
Figure 4
Post-operative X-ray of the pelvis post-arthroplasty.
Figure 5
Figure 5
Intraoperative clinical picture showing the black discoloration of femoral head.
Figure 6
Figure 6
Post-operative X-ray of the pelvis and the hip after the arthroplasty of the right and then the left hip.
Figure 7
Figure 7
Radiographs showing the arthritis of both the hips in the pre-operative radiograph and the post-operative X-ray showing the acceptable position of the prosthesis.
Figure 8
Figure 8
Patient demonstrating painless movement of the right hip post procedure during follow-up and the black pigmentation of the pinna.
See this image and copyright information in PMC

References

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