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Rapidly Progressive Osteoarthritis: a Review of the Clinical and Radiologic Presentation

  • Imaging (D Mintz, Section Editor)
  • Published:
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Abstract

Purpose of Review

The purpose of this paper is to review the distinct clinical and radiographic features that may lead to prompt diagnosis of rapidly progressive osteoarthritis (RPOA) and thus obviate unnecessary and costly diagnostic workup.

Recent Findings

RPOA is uncommon but is more frequently seen in practice because of the aging population. RPOA is a destructive arthropathy that occurs most commonly in elderly women but can also be seen in patients that have sustained trauma. The dramatic radiologic manifestations of RPOA can lead to diagnostic confusion with other arthropathies, infection, and osteonecrosis. RPOA was originally described in the hip but may also involve the shoulder. The etiology of RPOA is not well understood, but subchondral fracture probably plays a role in the development of dramatic destruction of the joint that is seen in affected patients. Early diagnosis may reduce the complexity of surgical management.

Summary

RPOA is an uncommon condition that occurs most frequently in elderly woman or in patients who have sustained trauma. Prompt recognition of the clinical and radiologic features of this arthropathy can reduce unnecessary diagnostic workup and complexity of surgical intervention.

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Authors and Affiliations

  1. Department of Radiology, Penn State Milton S. Hershey Medical Center, H066, 500 University Dr, Hershey, PA, 17033, USA

    Donald J. Flemming & Cristy N. Gustas-French

Authors
  1. Donald J. Flemming
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  2. Cristy N. Gustas-French
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Corresponding author

Correspondence to Donald J. Flemming.

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This article does not contain any studies with human or animal subject performed by any of the authors.

Additional information

This article is part of the Topical Collection on Imaging

Electronic Supplementary Material

ESM 1

Same patient with RPOA as in Figure 1. AP radiograph obtained 7 months after initial radiograph shows rapid and complete loss of superior lateral joint space. Note the paucity of osteophyte formation despite bone-on-bone articulation. (JPEG 326 kb)

ESM 2

77 year old woman with right hip pain. Coronal fat suppressed T2 weighted images of the hips show right hip joint space narrowing, extensive femoral neck bone marrow edema and synovitis of RPOA. Note the extensive soft tissue edema adjacent to the lateral and medial aspect of the right hip. The superior articular surface is collapsed (arrows). Chronic hip abductor tendon tear is also present. (JPEG 46.2 kb)

ESM 3

57 year old woman with left hip pain. Initial radiograph demonstrated minimal superior joint space (not shown). AP radiograph 5 months later shows complete superior lateral joint space loss in the left hip (black arrow). (JPEG 33.6 kb)

ESM 4

57 year old woman with left hip pain. Coronal T1 image of the left hip demonstrate ssubchondral fracture (thin white arrows) and flattening (thick white arrow) of the femoral head with relative sparing of the left acetabulum. (JPEG 390 kb)

ESM 5

57 year old woman with left hip pain. Initial radiograph demonstrated minimal superior joint space (not shown). Coronal T2 fat-suppressed MRI sequence of the left hip demonstrates subchondral fracture (thin white arrows) and flattening (thick white arrow) of the femoral head with relative sparing of the left acetabulum (curved arrow). (JPEG 345 kb)

ESM 6

77 year old woman with left hip pain. Radiograph obtained 11 months after onset of symptoms shows complete destruction of the femoral head (black arrows) and there are destructive changes of the acetabulum (thick white arrows). (JPEG 447 kb)

ESM 7

69 year old man with late manifestations of RPOA. AP view of the right hip shows remodeling of the femoral head (black arrows) with acetabular protrusio deformity (white arrows). Note the widened appearance of the joint on non-weight bearing radiography. (JPEG 509 kb)

ESM 8

68 year old woman with recent worsening of left shoulder pain. Posterior oblique radiograph shows flattening of the superior medial head. Note the calcification (white arrow) in the distended subacromial-subdeltoid bursa indicating full thickness rotator cuff tear. (JPEG 449 kb)

ESM 9

AP radiograph of shoulder in patient with rapidly destructive arthritis shows complete destruction of the humeral head with intraarticular debris mimicking neuropathic arthropathy. (JPEG 384 kb)

ESM 10

Axial CT image of rapidly destructive arthritis of the right shoulder. Remodeling of the humeral head is accompanied by marked distention of the subacromial-subdeltoid bursa (asterisks). Calcifications are seen both in the periphery of and within the distended bursa (arrows). (JPEG 21.9 kb)

ESM 11

Coronal CT image of rapidly destructive arthritis of the right shoulder. Remodeling of the humeral head is accompanied by marked distention of the subacromial-subdeltoid bursa (asterisks). Calcifications are seen both in the periphery of and within the distended bursa (arrows). (JPEG 22.3 kb)

ESM 12

62 year old woman with history of rotator cuff repair 2 years prior to onset of new recurrent shoulder pain. Coronal T1 image shows flattening of the medial humeral head with prominent bone marrow edema in the humeral head/neck and glenoid. Effusion and synovitis are also seen. (JPEG 406 kb)

ESM 13

62 year old woman with history of rotator cuff repair 2 years prior to onset of new recurrent shoulder pain. Coronal fat-suppressed fast spin echo T2 image shows flattening of the medial humeral head with prominent bone marrow edema in the humeral head/neck and glenoid. Effusion and synovitis are also seen. (JPEG 356 kb)

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Flemming, D.J., Gustas-French, C.N. Rapidly Progressive Osteoarthritis: a Review of the Clinical and Radiologic Presentation. Curr Rheumatol Rep 19, 42 (2017). https://doi.org/10.1007/s11926-017-0665-5

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