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Rapidly destructive arthrosis of the hip joint

Çarlı, Alparslan Bayram1; Akarsu, Selim2; Tekin, Levent2; Kıralp, Mehmet Zeki2

doi: 10.3760/cma.j.issn.0366-6999.20130707
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1Department of Physical Medicine and Rehabilitation, Bursa Military Hospital, Bursa, Turkey (Çarlı AB)

2Department of Physical Medicine and Rehabilitation, Gülhane Military Medical Academy Haydarpaşa Training Hospital, Istanbul, Turkey (Akarsu S, Tekin L and Kıralp MZ)

Correspondence to: Alparslan Bayram Çarlı, Department of Physical Medicine and Rehabilitation, Bursa Military Hospital, Bursa, Turkey (Tel: 90-224-2393841. Email: carlialp@gmail.com) Conflict of interest: none.

(Received March 12, 2013)

Edited by CUI Yi

To the editor: A 67-year-old man presented with left hip pain for the last one week. On detailed questioning, he declared that he had been under chemotherapy for prostate cancer for one year. His medical/family history was otherwise unremarkable. On physical examination, he had pain and mild limitation in his left hip joint. Radiographs demonstrated slight joint space narrowing and sclerosis, consistent with osteoarthritis. Laboratory tests including erythrocyte sedimentation rate and C-reactive protein were normal. No evidence of infection or inflammatory arthropathies was detected. He was given a non-steroidal anti-inflammatory drug. On the second visit (3 months later), he needed to use a wheelchair. His complaints got worse and he could not walk. There was no history of trauma. Radiographs revealed severe collapse and destruction of the femoral head. The patient was consulted to the urology department; and as he was not considered to have any metastasis, he underwent hip arthroplasty.

Rapidly destructive arthrosis (RDA) of the hip joint is an uncommon condition with unknown etiology whereby there is rapid destruction of both the acetabulum and the femoral head.1 It has been reported commonly in elderly females and with usually unilateral involvement.2 It occurs in a joint that initially appears to be normal or with arthrosis. However, in the following 6-12 months, joint destruction and disappearance of the femoral head ensue.1 Yamamoto et al3 proposed the pathogenesis to be a sort of secondary osteonecrosis superimposed on pre-existing osteoarthritis and trabecular fractures.

Reporting this patient of ours, we call attention of clinicians to a rare cause of rapid hip destruction. We also underscore the importance of repeat radiographs in patients with persistent or worsening hip pain without an obvious cause.

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REFERENCES

1. Postel M, Kerboull M. Total prosthetic replacement in rapidly destructive arthrosis of the hip joint. Clin Orthop 1970; 72: 138-144.
2. Yamamoto T, Schneider R, Iwamoto Y, Bullough PG. Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis. Skeletal Radiol 2010; 39: 189-192.
3. Yamamoto T, Schneider R, Iwamoto Y, Bullough PG. Rapid destruction of the hip joint in osteoarthritis. Ann Rheum Dis 2008; 67: 1783-1784.
© 2013 Chinese Medical Association