Rapidly destructive hip osteoarthritis

Rapidly destructive osteoarthritis of the hip, also known as rapidly progressive osteoarthritis of the hip, is a rare chondrolysis of unknown etiology which can progress to complete destruction of the femoral head. It is a diagnosis of exclusion.

Epidemiology

It is most common in middle age to elderly females in almost all reported case series.

Clinical presentation

Hip pain is the most frequently encountered symptom. In most cases, hip pain has been present for six months to three years (mean 1.4 years) .

Radiographic features

Plain film

Radiographic findings on plain film are a continuum that varies from rapidly progressive chondrolysis (> 2 mm/year or > 50% joint space narrowing/year)  to complete osteolysis of the femoral head.

MRI

Described features include :

• 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
  • also 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

See also

• osteoarthritis of the hip
• osteoarthritis of the hip (grading)

Siehe auch:

• Hüftkopfnekrose
• Koxarthrose

und weiter:

• Milwaukee-Schulter
• idiopathische kindliche Hüftkopfnekrose