Rapidly destructive osteoarthritis of the hip
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Rapidly destructive osteoarthritis of the hip is a rare chondrolysis of unknown aetiology which can progress to complete destruction of the femoral head. It is a diagnosis of exclusion.
Epidemiology
It is most common in middle aged to elderly females in almost all reported case series.
Clinical presentation
Hip pain is the most frequently encountered symptom. In most cases, hip pain was present for six months to three years (mean 1.4 years) 2.
Radiographic features
Plain film
Radiographic manifestationsfindings on plain film are a spectrum that vary from rapidly progressive chondrolysis (> 2 mm/year or > 50% joint space narrowing/year)1 to complete osteolysis of the femoral head.
MRI
Described features include1
-
joint effusion and synovitis
- present in 100% of patients in one report
- ill-defined bone marrow edema of the femoral head
- frequent extension to the intertrochanteric region
- present in 100% of patients in one report
- less common in the acetabulum (~ 83%)
- femoral head flattening (~ 92%)
- subchondral fracture
- subchondral cysts
Treatment and prognosis
The typical treatment is total hip arthroplasty.
Differential diagnosis
The differential diagnosis includes:
- avascular necrosis
- osteolytic metastases
- primary lytic bone lesion
-
osteomyelitis
- in particular tuberculosis or atypical mycobacteria
- CPPD arthropathy
- neuropathic arthropathy
-<p><strong>Rapidly destructive osteoarthritis of the hip </strong>is a rare chondrolysis of unknown aetiology which can progress to complete destruction of the femoral head. It is a diagnosis of exclusion.</p><h4>Epidemiology</h4><p>It is most common in middle aged to elderly females in almost all reported case series.</p><h4>Clinical presentation</h4><p>Hip pain is the most frequently encountered symptom. In most cases, hip pain was present for six months to three years (mean 1.4 years) <sup>2</sup>.</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Radiographic manifestations on plain film are a spectrum that vary from rapidly progressive chondrolysis (> 2 mm/year or > 50% joint space narrowing) <sup>1</sup> to complete osteolysis of the femoral head.</p><h5>MRI</h5><p>Described features include <sup>1</sup></p><ul>- +<p><strong>Rapidly destructive osteoarthritis of the hip </strong>is a rare chondrolysis of unknown aetiology which can progress to complete destruction of the femoral head. It is a diagnosis of exclusion.</p><h4>Epidemiology</h4><p>It is most common in middle aged to elderly females in almost all reported case series.</p><h4>Clinical presentation</h4><p>Hip pain is the most frequently encountered symptom. In most cases, hip pain was present for six months to three years (mean 1.4 years) <sup>2</sup>.</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Radiographic findings on plain film are a spectrum that vary from rapidly progressive chondrolysis (> 2 mm/year or > 50% joint space narrowing/year)<sup>1</sup> to complete <a title="Progressive massive osteolysis" href="/articles/gorham-disease">osteolysis</a> of the femoral head.</p><h5>MRI</h5><p>Described features include <sup>1</sup></p><ul>
-<a href="/articles/osteomyelitis">osteomyelitis</a><ul><li>in particular tuberculosis or atypical mycobacteria</li></ul>- +<a href="/articles/osteomyelitis">osteomyelitis</a><ul><li>in particular <a title="Tuberculosis" href="/articles/tuberculosis">tuberculosis</a> or <a title="Atypical mycobacterial infections" href="/articles/pulmonary-non-tuberculous-mycobacterial-infection-2">atypical mycobacteria</a>
- +</li></ul>
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