Skeletal Radiology

, Volume 39, Issue 2, pp 189–192 | Cite as

Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

  • Takuaki Yamamoto
  • Robert Schneider
  • Yukihide Iwamoto
  • Peter G. BulloughEmail author
Case Report


A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis.


Hip Rapidly destructive arthrosis Subchondral fracture Osteonecrosis 


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Copyright information

© ISS 2009

Authors and Affiliations

  • Takuaki Yamamoto
    • 1
  • Robert Schneider
    • 2
  • Yukihide Iwamoto
    • 1
  • Peter G. Bullough
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryKyushu UniversityFukuokaJapan
  2. 2.Department of RadiologyHospital for Special SurgeryNew YorkUSA
  3. 3.Department of Laboratory MedicineHospital for Special SurgeryNew YorkUSA

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