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
This is a preview of subscription content, log in to check access.
Postel M, Kerboull M. Total prosthetic replacement in rapidly destructive arthrosis of the hip joint. Clin Orthop. 1970;72:138–44.PubMedGoogle Scholar
Menkes CJ, Simon F, Delrieu F, Forest M, Delbarre F. Destructive arthropathy in chondrocalcinosis articularis. Arthritis Rheum. 1976;19:329–48.CrossRefGoogle Scholar
Slowman-Kovacs SD, Braunstein EM, Brandt KD. Rapidly progressive Charcot arthropathy following minor joint trauma in patients with diabetic neuropathy. Arthritis Rheum. 1990;33:412–7.CrossRefGoogle Scholar
O’Connor BL, Palmoski MJ, Brandt KD. Neurogenic acceleration of degenerative joint lesions. J Bone Joint Surg Am. 1985;67:562–72.CrossRefGoogle Scholar
Yamamoto T, Bullough PG. The role of subchondral insufficiency fracture in rapid destruction of the hip joint. A preliminary study. Arthritis Rheum. 2000;43:2423–7.CrossRefGoogle Scholar
Yamamoto T, Iwamoto Y, Schneider R, Bullough PG. Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis. 2008;67:150–3.CrossRefGoogle Scholar
Franchi A, Bullough PG. Secondary avascular necrosis in coxarthrosis: a morphologic study. J Rheumatol. 1992;19:1263–8.PubMedGoogle Scholar
Ilardi CF, Sokoloff F. Secondary osteonecrosis in osteoarthritis of the femoral head. Hum Pathol. 1984;15:79–83.CrossRefGoogle Scholar
Sissons HA, Nuovo MA, Steiner GC. Pathology of osteonecrosis of the femoral head. Skeletal Radiol. 1992;21:229–38.CrossRefGoogle Scholar
Yamamoto T, Yamaguchi T, Lee KB, Bullough PG. A clinicopathologic study of osteonecrosis in the osteoarthritic hip. Osteoarthritis Cartilage. 2000;8:303–8.CrossRefGoogle Scholar
Mitrovic DR, Riera H. Synovial, articular cartilage and bone changes in rapidly destructive arthropathy (osteoarthritis) of the hip. Rheumatol Int. 1992;12:17–22.CrossRefGoogle Scholar
Yamamoto T, Schneider R, Iwamoto Y, Bullough PG. Rapid destruction of the femoral head after a single intraarticular injection of corticosteroids into the hip joint. J Rheumatol. 2006;33:1701–4.PubMedGoogle Scholar