Rapidly Destructive Coxarthrosis Research Articles

Increased bone resorption that outpaces increased bone formation: An important pathology of rapidly destructive coxarthrosis.

Rapid joint destruction caused by rapidly destructive coxarthrosis (RDC) can increase surgical complexity and intraoperative blood loss. This single-center retrospective study investigates osteoporosis-related biomarkers for early RDC diagnosis and explores new treatment targets. We included 398 hip joints from patients who underwent total hip arthroplasty, examining medical records for preoperative patient demographics, bone mineral density of the hip and lumbar spine from dual-energy X-ray absorptiometry scans, and osteoporosis-related biomarkers including TRACP-5b, total P1NP, intact parathyroid hormone, and homocysteine. We compared RDC and osteoarthritis (OA) patients, and univariate analysis showed that RDC patients were older (p < 0.001) and had lower serum levels of albumin (p < 0.001) and higher serum levels of TRACP-5b, total P1NP (p < 0.001), and homocysteine (p = 0.006). Multivariable analysis showed that the ratio of serum TRACP-5b to total P1NP had a more significant difference in RDC patients than in OA patients (p = 0.04). Serum TRACP-5b levels were negatively correlated with the time between RDC onset and blood collection, and Japanese Orthopedic Association pain score. Receiver operating characteristic curve analysis revealed that the ratio of serum TRACP-5b to total P1NP had the highest area under the curve value. This study is the first to demonstrate that the ratio of serum TRACP-5b to total P1NP-increased bone resorption that outpaces increased bone formation-is significantly elevated in patients with RDC and that TRACP-5b is higher in the early stages of RDC. Inhibiting serum levels of TRACP-5b, activated osteoclasts, during early RDC may suppress disease progression.

Investigating sagittal spinopelvic alignment and equivalent stress on the femoral head in patients with rapidly destructive coxarthrosis.

Rapidly destructive coxarthrosis (RDC) is a rare syndrome of unknown etiology. This study evaluated sagittal spinopelvic alignment (SSPA) in patients with RDC and compared it with that in patients with hip osteoarthritis (HOA). In addition, finite element analysis (FEA) was performed to investigate the distribution of stress on the femoral head in RDC versus HOA. This retrospective study included patients who hadundergone primary total hip arthroplasty for RDC (n = 33) and HOA (n = 99; age- and sex-matched to patients with RDC) at three hospitals from June 2014 to September 2020. Preoperative SSPA parameters and inflammatory blood markers were compared between the two groups. FEA on the computed tomography data was performed for four patients from each group with similar pelvic tilt (PT) and lateral center-edge angle (LCEA). The distribution of Drucker-Prager equivalent stress was assessed at the loaded area of the femoral head. Patients with RDC had significantly higher PT, lower sacral slope, decreased lumbar lordosis (LL), higher sagittal vertical axis, and higher pelvic incidence minus LL than patients with HOA, indicating sagittal spinal imbalance. Blood test revealed patients with RDC had higher levels of inflammation markers than patients with HOA. FEA revealed no statistically significant difference in the degree of stress concentration or the maximum equivalent stress between the two groups when PT and LCEA were comparable. Patients with RDC tend to have sagittally imbalanced spine. Decreased acetabular coverage of the femoral head may heighten mechanical load of the hip joint in patients with RDC.

Aggressive Presentation and Rapid Progression of Osteonecrosis of the Femoral Head After COVID-19

BackgroundWe aim to report the consecutive patients diagnosed with osteonecrosis of femoral head (ONFH) following recovery from COVID-19 disease and elucidate the unique features of ONFH associated with COVID-19.MethodsConsecutive 22 patients (39 hips) recovered from COVID-19 and presented with ONFH from November 2020 to October 2021 were included. All the patients received corticosteroids as a supportive treatment during COVID-19. Patients were classified into two types based on the type of presentation, namely classic ONFH and rapidly destructive coxarthrosis (RDC) depending on radiographs, MRI, inflammatory markers and hip aspiration findings. Harris hip score was used to evaluate the functional outcome before and after treatment.ResultsThe mean time to diagnose of ONFH from the onset of hip symptoms was 39.3 days (range 10–90 days). The average duration of onset of hip symptoms after COVID 19 infection was 7.5 months (range 3 – 11 months). The average cumulative dose of methylprednisolone equivalent was 811 mg (range 200–2100 mg) and the average duration of steroid intake was 2.8 weeks. There was significant elevation in the inflammatory markers in RDC group compared to classic ONFH (p < 0.05). The Harris hip score improved from 63.6 ± 23.2 at presentation to 82.6 ± 9.6 after treatment (p < 0.05). Three patients had features of RDC. Among the three patients with RDC, two patients had rapid progression of ONFH and underwent total hip arthroplasty (THA). The third patient is awaiting a THA.ConclusionONFH after COVID-19 can have a varied presentation. While the most common presentation is like classical ONFH, some patients can have an acute and aggressive presentation with rapid destruction. They have features like elevated serological markers and extensive periarticular bone and soft tissue edema. A low cumulative dose of steroids in our patients suggests that the COVID-19-associated vasculitis may play a role in the pathogenesis of ONFH.

Total hip arthroplasty using hydroxyapatite-coated cementless cup for rapidly destructive coxarthrosis: Minimum 10-year follow-up

BackgroundPerforming total hip arthroplasty (THA) as early as possible is recommended for rapidly destructive coxarthrosis (RDC) as it causes pain that becomes progressively more severe. However, acetabular bone loss remains an issue in THA. Special devices, such as a Kerboull-type plate, may be used for acetabular bone defects, but the procedure is highly invasive and often the patients are elderly, further complicating matters. We retrospectively investigated the clinical and radiographic results of THA using conventional hydroxyapatite-coated cementless cup in RDC. MethodsA total of 32 patients (35 hips) with RDC were enrolled in the study with a minimum 10-year follow-up. All THAs were performed using conventional hydroxyapatite-coated cementless cup. All patients were evaluated clinically according to the Harris hip score (HHS). Acetabular bone deficiency was classified according to the American Academy of Orthopaedic Surgeons (AAOS) classification. ResultsEleven hips (31%) were AAOS type III, and none were type IV. Total HHS significantly improved from 36.5 to 79.4 (p < 0.01). Two cups exhibited loosening. The overall implant-associated survival rate after 10 years was 91.4%. ConclusionsClinical results of THA using conventional cementless implants for patients with RDC were acceptable. Thus, THA using conventional cementless implant is an effective and safe surgery for patients with RDC, minimizing surgical stress.

Sagittal spino-pelvic alignment in rapidly destructive coxarthrosis.

To investigate the sagittal spino-pelvic alignment (SSPA) in patients with rapidly destructive coxarthrosis (RDC). SSPA was investigated in 44 patients with RDC and 70 patients with hip osteoarthritis (HOA). The study included only female patients over the age of 70years because epidemiological reports indicate that RDC most commonly occurs in this group of patients. The SSPA parameters that were analyzed included lumbar lordosis (LL), lumbar range of motion (ΔLL), sacral slope (SS), pelvic incidence (PI), and pelvic tilt (PT). The pelvic inclination angle (PIA) in the supine position and the change in the PIA from the supine to the standing position (ΔPIA) were measured using anteroposterior pelvic radiographs. The values of these parameters were compared between the two groups. The levels of the SRS-Schwab classification modifiers were used to investigate the degree of sagittal malalignment. The RDC group showed significant lower LL, ΔLL and SS values, and significantly higher PT and ΔPIA values than the HOA group (P<0.01). With regard to the sagittal modifiers in the SRS-Schwab classifications of the patients, the PI-LL and PT levels of the RDC group were significantly worse than those in the HOA group (P<0.01). The present study suggests that the static factors of a reduction in the lumbar lordotic angle and greater posterior pelvic tilt, the dynamic factors of small ΔLL values and large ΔPIA values and the complex interaction of these two types of factors, may play important roles in the development of RDC.

Midterm outcome of total hip arthroplasty for rapidly destructive coxarthrosis.

To compare the midterm outcome in 12 women who underwent total hip arthroplasty (THA) for rapidly destructive coxarthrosis (RDC) and in 12 controls who underwent THA for osteoarthritis. Records of 12 women aged 50 to 80 (mean, 72.3) years who underwent THA for RDC after a mean of 9 (range, 4-11) months since symptom onset were reviewed. They were compared with 12 age-and sex-matched controls who underwent THA for primary or secondary osteoarthritis. Acetabular bone deficiency of the 12 RDC patients was classified as type I (n=7), type II (n=4), or type III (n=1). Type I was treated with cementless THA, and types II and III were treated with THA with a cemented acetabular component. The femoral component was cementless. Pre- and post-operative Harris Hip Score was assessed. Radiographs of the hip were evaluated for implant migration, osteolysis, and periprosthetic radiolucency in the acetabulum and proximal femur. The 12 women who underwent THA for RDC and the 12 controls who underwent THA for osteoarthritis were comparable in terms of pre-, intra-, and post-operative parameters. After a mean follow-up of 9.3 years, the mean Harris Hip Score improved from 38.3 to 81.1 in RDC patients and from 43.6 to 84.2 in controls (p=0.13). One RDC patient had dislocation but did not require revision surgery. One RDC patient developed a radiolucent line <2 mm in zones 1 and 7 of the femoral component, but no migration occurred. No patient had progression of bony destruction, loosening, osteolysis, migration, or radiolucency of the acetabular component. Despite the rapid destruction of the acetabulum and femoral head in RDC patients, cemented or cementless THA achieved a good midterm outcome comparable to that for patients with primary or secondary osteoarthritis.

Comparison of Perioperative Blood Loss in Primary Non-cemented Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis and Osteonecrosis of the Femoral Head.

PurposeThe purpose of this study is to compare the perioperative blood loss in primary non-cemented total hip arthroplasty (THA) performed for rapidly destructive coxarthrosis (RDC) with the perioperative blood loss in primary non-cemented THA for typical osteonecrosis of the femoral head (ONFH).Materials and MethodsFrom January 2000 to December 2013, 19 patients were diagnosed with RDC (group 1) and 40 patients were diagnosed typical Ficat stage IV ONFH (group 2), comparison of perioperative blood loss between group 1 and group 2 in primary noncemented THA was done. Patients with preoperative usage of steroid or anticoagulants medication and with hemodynamic abnormal blood test results were excluded. The blood loss was measured up to the fifth post operation day and calculated with formula proposed by Mercuriali, Inghilleri and Nadler.ResultsNon-compensated blood loss calculated in milliliters of red blood cells was 362 mL (standard deviation [SD], 187; range, 77-675) in group 1 and 180 mL (SD, 145; range, 53-519) in group 2. Compensated blood loss was 630 mL (SD, 180; range, 380-760) in group 1 and 503 mL (SD, 260; range, 190-1, 505) in group 2. The total blood loss after primary non-cemented THA is greater when surgery is performed for RDC than for ONFH, with the volume of 992 mL (SD, 300; range, 457-1, 434) in group 1 and 683 mL (SD, 360; range, 226-1, 975) in group 2 respectively.ConclusionTotal perioperative blood loss was significantly greater in RDC than in ONFH in primary non-cemented THA.

Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis in a Patient with Severe Platelet Deficiency due to Liver Cirrhosis and Immune Thrombocytopenic Purpura

Rapidly destructive coxarthrosis (RDC) causes rapid and extreme destruction of the hip joint, which was reported by Postel and Kerboull. RDC is commonly unilateral and occurs mostly in elderly women. Immune thrombocytopenic purpura (ITP) is characterized by a low platelet count that is the result of both immune-mediated platelet destruction and suppression of platelet production. In patients with ITP undergoing surgery, bleeding associated with a low preoperative platelet count can lead to unsuccessful outcomes. To the best of our knowledge, there has been only one report describing total hip arthroplasty (THA) for patients with ITP and there have been no reports of THA for RDC with a very low platelet count due to liver cirrhosis (LC) and ITP. We report the case of a patient who had right RDC and a very low platelet count due to LC and ITP in whom THA was successfully performed. Furthermore, this case was also unique in that her platelet count increased after THA. THA for right RDC might resolve ITP by relieving inflammation of the right hip since her platelet count recovered after THA.

Rapidly Destructive Inflammatory Arthritis of the Hip

Rapidly destructive coxarthrosis (RDC) is a rare syndrome that involves aggressive hip joint destruction within 6–12 months of symptom onset with no single diagnostic laboratory, pathological, or radiographic finding. We report an original case of RDC as an initial presentation of seronegative rheumatoid arthritis (RA) in a 57-year-old Caucasian woman presenting with 6 months of progressive right groin pain and no preceding trauma or chronic steroid use. Over 5 months, she was unable to ambulate and plain films showed complete resorption of the right femoral head and erosion of the acetabulum. There were inflammatory features seen on computed tomography (CT) and magnetic resonance imaging (MRI). She required a right total hip arthroplasty, but arthritis in other joints showed improvement with triple disease modifying antirheumatic drugs (DMARD) therapy and almost complete remission with the addition of adalimumab. We contrast our case of RDC as an initial presentation of RA to 8 RDC case reports of patients with established RA. Furthermore, this case highlights the importance of obtaining serial imaging to evaluate a patient with persistent hip symptoms and rapid functional deterioration.

Rapid hip osteoarthritis development in a patient with anterior acetabular cyst with sagittal alignment change.

Rapidly destructive coxarthrosis (RDC) is rare and develops unusual clinical course. Recent studies suggest multiple possible mechanisms of the development of RDC. However the exact mechanism of RDC is still not clear. The difficulty of the study on RDC is attributed to its rareness and the fact that the data before the onset of RDC is normally unavailable. In this report, we presented the patient having the radiographic data before the onset who had rapid osteoarthritis (OA) development after contralateral THA, which meets the current criteria of RDC. We thought that the increased posterior tilt of the pelvis after THA reinforced the stress concentration at pre-existed anterior acetabular cyst, thereby the destruction of the cyst was occurred. As a result the rapid OA was developed. We think that there is the case of rapid osteoarthritis developing due to alternating load concentration by posterior pelvic tilt on preexisting anterior acetabular cyst such as our patient among the cases diagnosed as RDC without any identifiable etiology. The recognition of sagittal alignment changes and anterior acetabular cyst may play important role in prediction and prevention of the rapid hip osteoarthritis development similar to RDC.

Mature and activated osteoclasts exist in the synovium of rapidly destructive coxarthrosis

We compared histological and functional findings in rapidly destructive coxarthrosis (RDC) and slowly progressive osteoarthritis (OA) to investigate whether osteoclasts contribute to the extensive bone destruction observed in RDC. A histological analysis of tissue specimens from the synovium obtained from 10 cases of RDC and 40 cases with OA of the hip was performed after staining for tartrate-resistant acid phosphatase (TRAP). The cells isolated from these tissue specimens from the synovium were cultured for 24 h, and the numbers of TRAP-positive giant cells were counted. Thereafter, we performed a resorption pit formation assay by isolated cells cultured on dentine slices for 7 days. The number of TRAP-positive multinuclear giant cells present in the synovial membrane obtained from RDC patients was significantly larger than that obtained from OA patients. Large lacunar resorption pits were only seen on the dentin slices in a culture of isolated cells from RDC patients without any stimulators. This is the first report, to our knowledge, to reveal that mature and activated osteoclasts exist only in the synovium of RDC and not in the OA synovium. This result might suggest that the underlying mechanism of RDC is therefore associated with osteoclastogenesis in the synovium.

MR Imaging of Osteonecrosis of the Femoral Head with Rapidly Destructive Coxarthrosis

Purpose : In this study, we investigated the magnetic resonance (MR) imaging characteristics of rapidly destructive coxarthrosis (RDC) caused by osteonecrosis of the femoral head. Material and Method : We reviewed 11 hip MR images (10 patients) of osteonecrosis of the femoral head with RDC. MR findings of 11 RDC were compared with those of Ficat stage IV osteonecrosis of the femoral head as a control. Results : The MR findings of osteonecrosis, involving the entire femoral head, bone marrow edema in the acetabulum, intraarticular loose bodies on the inferomedial portion of the hip joint, and synovial proliferation were significant in RDC as compared with those of osteonecrosis of the femoral head only. Conclusion : Distinct findings of MR imaging in conjunction with plain radiographs could be used to facilitate diagnosis, treatment, and prognosis in RDC.

Idiopathic osteonecrosis of the femoral head in the elderly.

Idiopathic osteonecrosis of the femoral head (ION) is a disease prevalent in adulthood, and its development in elderly persons is known to show a low incidence. To clarify its characteristics in elderly patients, radiological and histological examinations were performed on 18 patients aged 60 years or older histologically diagnosed as having ION. On roentgenography, three characteristic points were observed, 1) progress of collapse in the femoral head within a short period (12 cases, 66.7%), 2) narrowing in the joint space within a short period (6 cases, 33.3%), and 3) rapid destruction and resorption of the femoral head (4 cases, 22.2%). The lesion expanded to the acetabular region, and a course similar to that of so-called rapidly destructive coxarthrosis (RDC) was developing in 3 cases (16.7%). However, in these 3 cases, changes in the acetabular region were mild, compared with ordinary RDC, and they were considered different from common RDC. These radiological characteristics were found more clearly in women than in men. In the histopathological examination, severe degeneration in the cartilage of the femoral head was found, while wide infiltration of repairing tissue into the necrotic area was seen from the early stage. When necrotic trabecula were collapsed markedly and degraded severely, then destruction and resorption of bone expanded to non-necrotic regions in some cases. Osteogenic sclerotic line (the demarcation line), which has been often seen in ordinary ION, was not developed in most cases. These characteristics were more prominent in women.

急速破壊型股関節症と考えられた３症例

Three cases of an unusual, poorly recognized destructive hip arthropathy with radiographic findings of rapid severe joint destruction are presented. Case 1: An 81 year-old female presented with hip pain of 3 months duration and radiographs showed a rapidly destructive appearance of the femoral head. The patient had no clinical or laboratory evidence of sepsis or neurogenic disease. Case 2: A 55 year-old female presented with hip pain of 7 months duration. Radiographic findings developed into sudden destruction of the joint during an ordinary course of secondary osteoarthritis. Case 3: A 55 year-old female who had been treated with oral medications for nearly thirty years for schizophrenia, was injured in a fall. She complained of right coxalgia, but fracture of the femoral neck was not diagnosed by anteroposterior X-ray in the local orthopedic clinic. The pain didn't improve and she visited our hospital 2 months after the injury. Radiographs showed abnormal bone absorption of the femoral neck. The pathomechanism of rapidly destructive coxarthrosis (RDC) has not been clarified. However our cases support the features of RDC previously described in the literature. We should regard RDC as a special type of a syndrome causing hip joint destruction rather than one disease.

急速破壊型股関節症（ＲＤＣ）が疑われた９症例

This study analyzed clinical, radiological, and histological features of rapidly destructive coxarthrosis (RDC).Nine cases, most of whom were elderly females, were studied.Clinical examination revealed that 5 cases had some immunological abnormalities and 6 cases had minor trauma at onset. Radiologically, all casess demonstrated osteoporosis in the femoral head. Histological results showed osteonecrosis of trabecular bone in the femoral head and synovitis.

各種関節疾患におけるＩＬ‐１，ＩＬ‐６染色について

IL-1 and IL-6 producing cells in synovial tissues obtained from patients with Rheumatoid Arthritis (RA), Osteoarthritis (OA), Avascular Necrosis of the Femoral Head (ANF) and Rapidly Destructive Coxarthrosis (RDC) were observed by immunohistochemical method. Positive staining of IL-1 and IL-6 was seen in the synovial lining cells, vascular endothelial cells and fibroblasts in OA, ANF and RDC synovial tissues as well as RA synovial tissues. The results of immunohistochemistry found necessity to select the area taken from the synovial tissues.

急速に股関節破壊をきたした症例の検討

Rapidly Destructive coxarthrosis (RDC) has been reported these twenty years by a lot of authors. According to some papers, clinical findings of RDC has not changed so much and histopathological findings are now in consistent with femoral head necrosis, but X-ray findings of RDC at its initial stage and late stage are not in total accord. We experienced two cases that seemed to be RDC in the last six years. It might be said that nature of RDC is avasculan necrosis occurring with proliferation of sinovium at early stage and besides mechanical and immunological factors, bone fragments and crystals freed from exposed subchondral bone might accelerate joint damage by interacting with sinovium and causing release of destructive factors as well as synovial proliferation. In addition, we studied two cases of osteoradionecrosis that reached similar advanced stage clinically and radiologically to that of RDC.