Abstract
BackgroundRapidly destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population.MethodsA series of cases from North Wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities.ResultsRapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average 14 months) in 18 patients documented rapid hip destruction, involvement being unilateral in 13 cases. All patients underwent total hip arthroplasty, and osteoarthritis was confirmed at pathologic examination.ConclusionThe authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. These cases are unsuitable for being placed on long waiting list due to technical difficulties in delayed surgery and compromised outcome following surgery.
Highlights
Destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population
Progressive hip disease (RDHD) is a rare syndrome of unknown etiology and distinct from ischaemic necrosis of the femoral head, resulting in rapid deterioration of both the femoral and acetabular aspects of the hip joint with disappearance of the femoral head as first reported by Forestier [1]
The natural history of hip osteoarthrosis has been extensively documented [1,2,3] with well known inter-racial variations [4]
Summary
Destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population. Little has been written about variation in natural history within a population and only scant mention of discrete subgroup of this type appears in the English language journals, with studies originating mainly in continental Europe Attempts to characterise this disorder are limited to case reports where inconsistent associations have been made. Failure to act on rapidly worsening hip arthrosis is well recognised to compromise the success of surgery and is clearly undesirable, making these unsuitable for being placed on long waiting lists. If such cases can be identified, it should be made possible to offer them a priority for treatment
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