Rapidly destructive hip disease

Rapidly destructive coxopathy due to dialysis amyloidosis: a case report

Rapidly destructive coxopathy (RDC) is a disease that is sometimes seen in geriatric patients. A total hip arthroplasty (THA) is mostly chosen to treat the RDC, but few cases are known that received THAs due to RDC associated with dialysis amyloidosis. We report a case of RDC due to dialysis amyloidosis with special references to its pathophysiology. The case involved a 61-year-old male who had been on dialysis for seven years due to diabetic nephropathy. At his first visit, the radiographs showed collapse and flattening of the femoral head, which progressed within a month. Magnetic resonance imaging for the hip disclosed bone marrow edoema of the acetabulum and sclerosis of the subchondral bone of the femoral head. Biochemical analyses for the blood revealed high inflammatory reactions with elevated C-reactive protein and white blood cell count, but the joint fluid cultures were negative for general bacteria, tubercle bacillus, and nontuberculous mycobacteria. As he did not have gastrointestinal disorders or inflammatory arthritis other than the left hip and no disease that caused elevated inflammatory reactions was observed, we diagnosed the patient with RDC due to dialysis amyloidosis, and a THA was performed. Pathological findings for the synovium collected during surgery showed infiltration of the inflammatory mononuclear cells and vascular hyperplasia. The synovial tissues were extensively stained with an antibody to β2-microglobulin. Many tartrate-resistant acid phosphatase-positive multinucleated cells were also observed in the synovium. One year after surgery, his left hip pain disappeared and he returned to work.

Rapidly Progressive Osteoarthritis: a Review of the Clinical and Radiologic Presentation

PURPOSE OF REVIEW

The purpose of this paper is to review the distinct clinical and radiographic features that may lead to prompt diagnosis of rapidly progressive osteoarthritis (RPOA) and thus obviate unnecessary and costly diagnostic workup.

RECENT FINDINGS

RPOA is uncommon but is more frequently seen in practice because of the aging population. RPOA is a destructive arthropathy that occurs most commonly in elderly women but can also be seen in patients that have sustained trauma. The dramatic radiologic manifestations of RPOA can lead to diagnostic confusion with other arthropathies, infection, and osteonecrosis. RPOA was originally described in the hip but may also involve the shoulder. The etiology of RPOA is not well understood, but subchondral fracture probably plays a role in the development of dramatic destruction of the joint that is seen in affected patients. Early diagnosis may reduce the complexity of surgical management. RPOA is an uncommon condition that occurs most frequently in elderly woman or in patients who have sustained trauma. Prompt recognition of the clinical and radiologic features of this arthropathy can reduce unnecessary diagnostic workup and complexity of surgical intervention.

MR imaging of tumors and tumor-like lesions of the hip

In conclusion, a wide variety of tumors and tumor-like conditions have a predilection for the hip. The imaging evaluation of these lesions begins with radiographs. Radiographs can depict the extent of disease; any characteristic calcifications; and osseous changes, such as remodeling,periosteal reaction, or destruction. MR imaging has emerged as the preferred imaging modality of choice for evaluating osseous and soft tissue masses of the hip by providing information for diagnosis and staging. The MR imaging signal characteristics and enhancement patterns of malignant and benign hip tumors permit specific diagnoses in some cases. Synovial-based tumor-like processes of the hip can be characterized by MR signal characteristics, such as the hemosiderin within PVNS or the cartilage within synovial chondromatosis. Finally, MR imaging can serve to exclude underlying osseous or soft tissue tumors when radiographs display aggressive features of tumor-like processes.

Rapidly destructive coxopathy after subchondral insufficiency fracture of the femoral head

Rapidly destructive coxopathy (RDC) is a rare disorder, and its pathophysiology is unknown. Here, we report a case of RDC evaluated by roentgenography and magnetic resonance imaging, from the onset of hip pain without changes on roentgenograms, to the terminal stage with collapse of the femoral head. Our serial radiological findings clearly illustrate the entire process of RDC, especially the initial stage. Subchondral insufficiency fracture of the femoral head seems to be an important preliminary event in the development of RDC.

Subchondral insufficiency fractures of the femoral head

The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment.

Rapidly destructive osteoarthritis of the hip: MR imaging findings

OBJECTIVE

The aim of our study was to describe the MR imaging findings in patients with rapidly destructive osteoarthritis of the hip.

CONCLUSION

The key MR imaging features of rapidly destructive hip osteoarthritis include joint effusion (100%), bone marrow edemalike pattern in the femoral head and neck (100%) or acetabulum (83%) or both, femoral head flattening (92%), and cystlike subchondral defects (83%). Additional findings are low-signal-intensity lines (33%) in the femoral epiphysis, bandlike areas of low signal intensity in the upper pole of the femoral head (8%), and focal signal abnormalities in the adjacent soft tissues (33%) on short tau inversion recovery MR images, fat-suppressed T2-weighted MR images, and fat-suppressed gadolinium-enhanced T1-weighted MR images.

Early MRI findings of rapidly destructive coxopathy

To diagnose rapidly destructive coxopathy (RDC) in its early stages and understand the pathomechanism of associated joint destruction, ten cases of RDC were followed by periodic MRI from onset of the disease. In the initial stage (stage 1) of RDC, when radiographs revealed slight narrowing of the joint space, a small subchondral area of low signal intensity was observed on T(1)-weighted images (T1WI) and inhomogeneous high intensity was observed on T(2)-weighted images (T2WI) in the antero-lateral portion of the femoral head. When radiographs showed obliteration of the joint space (stage 2), MRI revealed a diffuse area of low intensity on TIWI and high intensity on T2WI in the proximal femur, including the femoral neck and head, suggesting extensive bone marrow edema. The femoral head and acetabulum were aggressively destroyed (stage 3) in all cases 3 to 6 months after the diffuse abnormal pattern was observed on MRI. MRI in stage 3 cases showed low intensity areas on both T1WI and T2WI. RDC did not show the band-like pattern of low intensity on T1WI and high intensity on T2WI that typify MRI findings in cases of osteonecrosis. When joint space narrowing is observed radiographically, the diffuse abnormal pattern of low intensity on T1WI and high intensity on T2WI induced by a subchondral small lesion might be an early sign of RDC.

Ischemic necrosis of the entire femoral head and rapidly destructive hip disease: potential causative relationship

OBJECTIVE

Rapidly destructive hip disease (RDHD) is an uncommon disorder of the hip that has been considered a disease of unknown cause and distinct from ischemic necrosis of the femoral head. The objective of this study was to investigate ischemic necrosis of the femoral head as one potential cause of RDHD.

DESIGN AND PATIENTS

In 600 patients who underwent MR imaging of the hip, 20 cases of ischemic necrosis involving the entire femoral head in 18 patients (3%) were retrospectively studied with routine radiography and MR imaging. All patients had surgically confirmed ischemic necrosis of the femoral head.

RESULTS AND CONCLUSIONS

All patients showed rapid destruction of the femoral head on routine radiography and MR imaging as compared with the gradual onset of clinical symptoms. Plain radiographs showed several bone fragments at the inferomedial aspect of the femoral head (75%), acetabular erosions (55%), eccentric depression at the lateral articular surface of the femoral head conforming to the adjacent acetabulum (35%), and mild osteoarthritis (15%). Bone sclerosis was often present at sites of impaction between the femoral head and the acetabulum. MR imaging showed marked distention of the joint capsule in all cases. In 14 of 20 cases, the contents of the joint space showed predominantly low or intermediate signal intensity on T1- and T2-weighted images. Ischemic necrosis involving the entire femoral head may represent one of the causes of RDHD.