AJR 2002; 179:657-663
© American Roentgen Ray Society
Rapidly Destructive Osteoarthritis of the Hip: MR Imaging Findings
Nathalie Boutry1,
Christelle Paul1,
Xavier Leroy2,
David Fredoux1,
Henri Migaud3 and
Anne Cotten1
1 Department of Radiology, Hôpital Roger Salengro, Blvd. du Professeur
Leclercq, CHRU de Lille, 59037 Lille Cedex, France.
2 Department of Pathology, Hôpital Roger Salengro, CHRU de Lille, 59037
Lille Cedex, France.
3 Department of Orthopaedics, Hôpital Roger Salengro, CHRU de Lille, 59037
Lille Cedex, France.
Received September 24, 2001;
accepted after revision March 13, 2002.
Address correspondence to N. Boutry.
Abstract
OBJECTIVE. The aim of our study was to describe the MR imaging
findings in patients with rapidly destructive osteoarthritis of the hip.
CONCLUSION. The key MR imaging features of rapidly destructive hip
osteoarthritis include joint effusion (100%), bone marrow edemalike pattern in
the femoral head and neck (100%) or acetabulum (83%) or both, femoral head
flattening (92%), and cystlike subchondral defects (83%). Additional findings
are low-signal-intensity lines (33%) in the femoral epiphysis, bandlike areas
of low signal intensity in the upper pole of the femoral head (8%), and focal
signal abnormalities in the adjacent soft tissues (33%) on short tau inversion
recovery MR images, fat-suppressed T2-weighted MR images, and fat-suppressed
gadolinium-enhanced T1-weighted MR images.
Introduction
Rapidly destructive osteoarthritis of the hip is a unique hip disorder
characterized by rapid chondrolysis (> 2 mm in 1 year or 50% joint-space
narrowing in 1 year) and no evidence of other forms of rapidly destructive
arthropathy [1]. Clinical
history and follow-up radiographs are sufficient for making the diagnosis in
most cases. However, less typical features could cause diagnostic problems. MR
imaging may offer an alternative noninvasive technique for evaluating this
condition. Little information is available on MR imaging findings in patients
with rapidly destructive hip osteoarthritis
[2,
3]; to our knowledge, no other
series has described the MR imaging findings of this disorder.
Materials and Methods
We retrospectively reviewed MR images of 12 patients in whom rapidly
destructive hip osteoarthritis was diagnosed. These cases occurred over an
8-year period. Patients were included in this study if they satisfied the
accepted diagnostic criteria for rapidly destructive hip osteoarthritis
[1], which were based on
results of history, conventional radiography, and the clinical course of the
disease. In seven patients, histopathologic confirmation was available.
Specifically, before MR imaging, all patients presented with rapid progression
of hip pain. In all patients, analyses of initial and follow-up radiographs
showed rapid joint destruction within 1 year. Patients were excluded if they
had a history of other conditions that might result in destructive hip
arthropathy, including septic arthritis, inflammatory arthritis, osteonecrosis
with secondary osteoarthritis, pyrophosphate-associated arthropathy, and
neuropathic osteoarthropathy.
The 12 patients who satisfied these criteria comprised four men and eight
women. The mean age at presentation was 74 years, ranging from 47-81 years.
All patients had hip pain (five, on the right; seven, on the left) with a
duration of symptoms ranging between 3 months and 1 year (mean, 7 months)
before MR imaging. One of the 12 patients had bilateral disease; MR imaging of
only one hip was performed in this patient. The major complaints of the
patients were pain (n = 11) and restricted movement (n =
5).
Before MR imaging, the possibility of rapidly destructive hip
osteoarthritis was suspected in seven patients. However, clinical findings
simulated those of other diseases such as osteonecrosis (n = 6),
spontaneous fracture (n = 3), septic arthritis (n = 2), and
transient osteoporosis (n = 1), and for this reason, MR imaging was
performed in all patients. The time between the first radiography and MR
imaging ranged from 2 to 12 months (mean, 6 months). Synovial fluid analysis
was available in two patients who had been suspected of having septic
arthritis; the results of bacteriologic studies in these patients were
negative.
,
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Fig. 1A. —Rapidly destructive hip osteoarthritis in 68-year-old woman
with right-sided hip pain. Anteroposterior radiograph obtained at onset of
symptoms shows moderate superolateral joint-space narrowing and small
subchondral cystic lesion in acetabulum.
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Fig. 1B. —Rapidly destructive hip osteoarthritis in 68-year-old woman
with right-sided hip pain. Anteroposterior radiograph obtained 6 months after
A shows superior loss of joint space, flattening of femoral head, and
heterogeneous bone aspect.
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Follow-up radiographs and clinical reports were available for review in all
patients. Anteroposterior views of the pelvis and anteroposterior and lateral
views of the symptomatic hips depicted progressive joint destruction in all
patients. In 11 patients, radiographs showed narrowing of the superolateral
joint space, whereas the superomedial part of the joint was involved in one
patient. Additional findings included varying degrees of subchondral
sclerosis, subchondral cyst formation, bone destruction, and mild
osteophytosis. Furthermore, anteroposterior views of the knees had been
obtained in all patients; these showed no chondrocalcinosis. None of our
patients had a history of polyarthritis. However, four patients showed
characteristic changes of osteoarthritis in the contralateral hip (n
= 2) and the knees (n = 2). In one patient, clinical reports
mentioned degenerative changes in the spine. All patients underwent total hip
replacement resulting in relief of symptoms. At no time did any of them
receive antibiotics. Resected femoral head specimens were available in seven
patients.,
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Fig. 2A. —Rapidly destructive hip osteoarthritis in 57-year-old man
with right-sided hip pain. Anteroposterior radiograph obtained at onset of
symptoms shows moderate joint-space narrowing and subchondral sclerosis.
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Fig. 2B. —Rapidly destructive hip osteoarthritis in 57-year-old man
with right-sided hip pain. Anteroposterior radiograph obtained 3 months after
A reveals superior joint-space narrowing. Mild subchondral bone
sclerosis is seen with no osteophytes.
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Field strength for the MR imaging ranged from 0.5 to 1.5 T. All protocols
included T1-weighted MR imaging of the symptomatic hips, both in the coronal
and sagittal planes. All patients received IV gadolinium contrast material.
Fat-suppressed gadolinium-enhanced T1-weighted MR images were obtained in 11
patients. Short tau inversion recovery images or fat-suppressed T2-weighted
images of the involved hips were obtained in coronal (n = 8) and
sagittal (n = 6) planes.
The MR imaging studies were retrospectively reviewed by two experienced
musculoskeletal radiologists. Consensus agreement was achieved. Data recorded
from MR imaging studies included the presence or absence of a joint effusion,
synovitis, and signal intensity changes in bone marrow and soft tissues.
Effusion was assumed when areas of high signal intensity were found in the
joint space on T2-weighted MR images. The amount of joint fluid was graded
from 0 to 3 according to the staging system described by Mitchell et al.
[4]: 0, none; 1, minimal; 2,
enough fluid to surround the femoral neck; and 3, sufficient fluid to distend
the joint capsule. Synovitis was diagnosed by comparing unenhanced and
contrast-enhanced T1-weighted MR images for linear or curvilinear enhancement
in the site of the normal synovium. Synovial membrane hypertrophy was
subjectively graded with a 3-point scale: 0, absent; 1, moderate; 2, frank
synovitis. Other MR imaging findings were recorded, including information
regarding the additional subchondral findings.
Results
All 12 patients (100%) had hip joint effusion (grade 2 fluid [n =
2]; grade 3 fluid [n = 10]). In two patients (17%), three
intraarticular loose bodies were shown on MR imaging. All 12 patients had
evidence of synovitis on MR images (moderate [n = 3]; frank
[n = 9]) (Figs. 1C and
1D).
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Fig. 1C. —Rapidly destructive hip osteoarthritis in 68-year-old woman
with right-sided hip pain. Coronal (C) and sagittal (D)
fat-suppressed gadolinium-enhanced T1-weighted MR images (TR/TE, 720/20)
obtained 6 months after onset of symptoms show frank synovitis (curved
arrow). Note presence of cystlike subchondral defects (straight
arrows) at weight-bearing surfaces of femoral head and acetabulum.
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Fig. 1D. —Rapidly destructive hip osteoarthritis in 68-year-old woman
with right-sided hip pain. Coronal (C) and sagittal (D)
fat-suppressed gadolinium-enhanced T1-weighted MR images (TR/TE, 720/20)
obtained 6 months after onset of symptoms show frank synovitis (curved
arrow). Note presence of cystlike subchondral defects (straight
arrows) at weight-bearing surfaces of femoral head and acetabulum.
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MR imaging of the bone marrow edema pattern, an ill-defined marrow area of
low signal intensity on T1-weighted MR images and of high signal intensity on
short tau inversion recovery images or on fat-suppressed T2-weighted images,
was identified in the femoral head in 12 patients (100%) and in the acetabulum
in 10 patients (83%) (Figs. 2C
and 2D). In all 12 patients,
diffuse signal abnormalities were found in the marrow of the femoral head and
neck, with frequent (10 patients) abnormal findings extending into the
intertrochanteric area (Fig.
3D). An edemalike abnormality on MR imaging, however, was more
prominent at the weight-bearing areas (nine patients).
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Fig. 2C. —Rapidly destructive hip osteoarthritis in 57-year-old man
with right-sided hip pain. Coronal T1-weighted MR image (TR/TE, 552/14)
obtained 4 months after onset of symptoms shows ill-defined
low-signal-intensity area in femoral head and, to lesser degree, in
acetabulum.
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Fig. 2D. —Rapidly destructive hip osteoarthritis in 57-year-old man
with right-sided hip pain. Sagittal short tau inversion recovery MR image
(5216/60; inversion time, 150 msec) obtained 4 months after onset of symptoms
shows ill-defined high-signal-intensity area in femoral head.
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Fig. 3D. —Rapidly destructive hip osteoarthritis in 72-year-old woman
with left-sided hip pain. Coronal short tau inversion recovery MR image
(5216/60; inversion time, 150 msec) obtained 5 months after onset of symptoms
reveals markedly increased signal intensity in femoral head and neck and grade
3 amount of fluid in joint. Note low-signal-intensity line (arrows)
in upper pole of femoral head.
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Findings in 11 patients (92%) showed evidence of femoral head flattening
(severe in two patients) at the weight-bearing surfaces associated with
superolateral subluxation in eight patients (67%). MR imaging revealed small
marginal osteophytes along the femoral neck and the anterolateral aspect of
the acetabulum in 10 patients (83%) and in two patients (17%),
respectively.
Miscellaneous subchondral changes were also observed on MR images. Findings
in one patient (8%) showed evidence of a low-signal-intensity subchondral area
on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted MR images. This
abnormality was located at the superior pole of the femoral head (Figs.
4C and
4D). In four patients (33%),
the femoral head exhibited thin lines of low signal intensity on both T1- and
T2-weighted MR images (Figs.
3D and
3E). These lesions coursed
parallel to the articular surface and were suggestive of subchondral
fractures. In 10 patients (83%), cystic defects were depicted in areas
adjacent to the subchondral bone plate (Figs.
1C and
1D). Typically, these cysts
were located at the weight-bearing surfaces of femoral head and acetabulum;
they ranged from 2 to 15 mm in diameter and exhibited high signal intensity on
T2-weighted or gadolinium-enhanced T1-weighted MR
images.,,
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Fig. 4C. —Rapidly destructive hip osteoarthritis in 73-year-old-woman
with right-sided hip pain. Sagittal short tau inversion recovery MR image
(TR/TE, 5216/60; inversion time, 150 msec) (C) and sagittal
fat-suppressed gadolinium-enhanced T1-weighted MR image (612/14) (D)
obtained 7 months after onset of symptoms show increased signal intensity in
femoral head and acetabulum with low-signal-intensity subchondral area
(arrowheads) in upper pole of femoral head.
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Fig. 4D. —Rapidly destructive hip osteoarthritis in 73-year-old-woman
with right-sided hip pain. Sagittal short tau inversion recovery MR image
(TR/TE, 5216/60; inversion time, 150 msec) (C) and sagittal
fat-suppressed gadolinium-enhanced T1-weighted MR image (612/14) (D)
obtained 7 months after onset of symptoms show increased signal intensity in
femoral head and acetabulum with low-signal-intensity subchondral area
(arrowheads) in upper pole of femoral head.
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Fig. 3E. —Rapidly destructive hip osteoarthritis in 72-year-old woman
with left-sided hip pain. Sagittal fat-suppressed gadolinium-enhanced
T1-weighted MR image (729/14) obtained 5 months after onset of symptoms shows
increased signal intensity in subchondral areas of femoral head and
acetabulum. Note low-signal-intensity line (arrows) in upper pole of
femoral head.
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Fig. 3A. —Rapidly destructive hip osteoarthritis in 72-year-old woman
with left-sided hip pain. Anteroposterior radiograph obtained at onset of
symptoms shows no significant joint-space narrowing and small lateral
acetabular osteophyte.
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Fig. 3B. —Rapidly destructive hip osteoarthritis in 72-year-old woman
with left-sided hip pain. Anteroposterior radiograph obtained 6 months after
A shows superior joint-space loss and small osteophytes on lateral
aspect of femoral head and acetabulum.
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Fig. 3C. —Rapidly destructive hip osteoarthritis in 72-year-old woman
with left-sided hip pain. Sagittal T1-weighted MR image (TR/TE, 480/14)
obtained 5 months after onset of symptoms shows abnormally low signal
intensity in superior parts of both femoral head and acetabulum. Note
joint-space narrowing.
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In four patients (33%), short tau inversion recovery, fat-suppressed
T2-weighted, or fat-suppressed gadolinium-enhanced T1-weighted MR images
showed signal abnormalities in the adjacent soft tissues
(Fig. 5C).
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Fig. 5C. —Rapidly destructive hip osteoarthritis in 73-year-old-woman.
Coronal fat-suppressed gadolinium-enhanced T1-weighted MR image (TR/TE,
720/18) obtained 4 months after onset of symptoms shows high-intensity signal
in femoral neck and acetabulum. Note focal signal abnormalities
(arrows) of soft tissues.
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Resected femoral head specimens were available in seven patients. No
evidence of primary osteonecrosis, inflammatory arthritis, or crystal
deposition was observed in these specimens. The pathologist made the diagnosis
of osteoarthritic changes in all patients. On microscopic examination, all
specimens exhibited severe degenerative changes in the cartilage and
subchondral bone sclerosis. Hypervascularity was a frequent finding
(n = 6) in the subchondral bone
(Fig. 1E). Abnormal trabeculae,
either thickened (n = 3) or thinned (n = 4), were commonly
observed in the subarticular region. Subchondral defects were identified in
three patients; the defects contained fibroconnective tissue (n = 2)
or mucoid degeneration (n = 1). All sections of the femoral head
showed normal fatty bone marrow with spotty remnants of hematopoietic marrow.
In three of the four patients with findings of epiphyseal lines on MR imaging,
histologic examination revealed trabecular fractures in the vicinity of the
articular surface. Small marginal osteophytes were identified in three cases.
Less striking histologic findings included foci of fibrosis, interstitial
edema and hemorrhage in the marrow spaces, focal marrow fat necrosis, and
areas of reactive bone formation and bone resorption. Sections of the synovium
were available in six patients; four of these showed reactive changes.
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Fig. 1E. —Rapidly destructive hip osteoarthritis in 68-year-old woman
with right-sided hip pain. On moderate microscopic examination,
photomicrograph of histologic section shows prominent hypervascularity in
subchondral bone. Note presence of numerous capillaries (arrowheads)
and thinned trabeculae (arrows). (H and E, x40)
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Discussion
Lequesne [1] and Postel and
Kerboull [5] were the first to
coin the term "rapid destructive hip osteoarthritis" in 1970. Over
the next 30 years, subsequent series and reports
[2,
3,
6,7,8,9]
emphasized the clinical, radiographic, and pathologic findings of this unusual
condition.
Typically, patients with rapidly destructive hip osteoarthritis present
with rapid destruction of the hip joint within months of the onset of
symptoms. In all cases, a rapid clinical course of hip pain is the consistent
common clinical symptom. The patients are predominantly women, and the average
age at onset (60-70 years) is greater than that of most patients with ordinary
osteoarthritis.,
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Fig. 4A. —Rapidly destructive hip osteoarthritis in 73-year-old-woman
with right-sided hip pain. Anteroposterior radiograph obtained at onset of
symptoms shows moderate superior and lateral joint-space loss.
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Fig. 4B. —Rapidly destructive hip osteoarthritis in 73-year-old-woman
with right-sided hip pain. Anteroposterior radiograph obtained 7 months after
A shows major loss of joint space, moderate subchondral sclerosis, and
no significant osteophytosis.
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Initially, conventional radiographs show either no abnormality or mild
osteoarthritic changes. Follow-up radiographs, obtained within a few months,
show severe progressive joint destruction with focal joint-space narrowing and
extensive subchondral bone loss in the femoral head or acetabulum or both.
Other characteristic subchondral changes include flattening of the femoral
head in a hatchetlike deformity, occasional subluxation, mild bone sclerosis,
and a few osteophytes [2,
8,
9]. However, rapid chondrolysis
with progressive loss of joint space is the first manifestation of the
disease. In 1970, Lequesne [1]
proposed a standardized definition of rapid chondrolysis: chondrolysis greater
than 2 mm in 1 year or 50% joint-space narrowing in 1 year.
The histologic findings of rapidly destructive hip osteoarthritis are those
of osteoarthritis, with severe degenerative changes in articular cartilage
[2,
8,
9]. However, absent or minimal
osteophyte formation is commonly observed.
In our series, the clinical, radiologic, and pathologic features of rapidly
destructive hip osteoarthritis are consistent with previous reports. Eight
(67%) of 12 patients were elderly women, and one of 12 patients had bilateral
disease. All patients presented with hip pain and rapid progression of
symptoms. In all patients, sequential radiographs showed rapid joint
destruction with joint-space narrowing and paucity of osteophytes or
subchondral bone loss, or both. Radiographically, the differential diagnosis
included septic arthritis, inflammatory arthritis, osteonecrosis with
secondary osteoarthritis, pyrophosphate-associated destructive arthropathy, or
neuropathic osteoarthropathy. However, clinical history, laboratory findings,
and successful surgical outcome did not support any of these entities.
Furthermore, none of our patients exhibited chondrocalcinosis (pelvis, knees)
radiographically or histopathologically. Moreover, pathologic confirmation of
osteoarthritis was available in seven cases.
Despite the widespread application of MR imaging as the modality of choice
for evaluation of painful hip, we could find only two reports describing the
MR appearances of rapidly destructive hip osteoarthritis in the literature in
English [2,
3]. Therefore, to our
knowledge, our study of 12 patients is the largest series to date. A
nonspecific joint effusion was seen in all patients in our series. In nine
patients (75%), MR imaging features were consistent with the presence of
prominent synovitis in the hip joint (Figs.
1C and
1D). Pathologic examination
revealed findings compatible with secondary reactive synovitis in 67% (4/6) of
patients. Bock et al. [2] and
Rosenberg et al. [8] reported
similar histologic findings.
In our study, we commonly observed MR imaging findings consistent with bone
marrow edemalike pattern in the femoral head or acetabulum, as reported by
Yamamoto and Bullough [3].
Conversely, in the report by Bock et al.
[2], findings of conventional
T2-weighted MR images of the hip in two patients showed a normal-appearing
bone marrow. However, short tau inversion recovery and other fat-suppression
techniques used in our study improve the sensitivity of MR imaging in the
detection of bone edema.
In four cases (33%), evidence of subchondral fractures was shown on MR
imaging (Figs. 3D and
3E), and this was confirmed
histopathologically in three cases. Although their reports included only two
cases, Yamamoto and Bullough
[3] also described the presence
of epiphyseal low-signal-intensity lines on MR images. Furthermore, these
authors suggested that rapidly destructive hip osteoarthritis may result from
a subchondral insufficiency fracture, perhaps related to osteopenia. However,
none of their patients underwent measurement of bone mineral density. Because
of the retrospective nature of our study, the bone mineral density in our
patients was not
measured.,
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Fig. 5A. —Rapidly destructive hip osteoarthritis in 73-year-old-woman.
Anteroposterior radiograph obtained at onset of symptoms shows moderate
superolateral joint-space narrowing with small osteophytes along lateral
aspect of acetabulum.
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In one patient (8%), a bandlike subchondral area showed low signal
intensity on images obtained with each of the three sequences (T1-weighted,
T2-weighted, and contrast-enhanced T1-weighted MR images) (Figs.
4C and
4D). Zanetti et al.
[10] reported that subchondral
areas of low signal intensity on both T1- and T2-weighted MR images were
composed mainly of abnormal tissue (40% necrotic remodeled trabeculae, 12%
bone marrow fibrosis, and 9% bone marrow necrosis) and of smaller proportions
of several histologic abnormalities. In our series, the patient with the
bandlike subchondral area did not undergo biopsy.
In 10 (83%) of 12 patients, cystlike subchondral defects were more commonly
seen at the weight-bearing areas (Figs.
1C and
1D). Pathologic examination
showed evidence of mucoid degeneration or granulation tissue that may
correspond to regions of high signal intensity on T2-weighted and
gadolinium-enhanced T1-weighted MR images.
In 33% of patients, focal signal abnormalities were detected in the
adjacent soft tissues (Fig.
5C). The significance of these findings is uncertain. Such signal
intensity alterations are not necessarily synonymous with septic arthritis.
However, the radiologist should be aware of this potentially misleading MR
imaging feature of rapid destructive hip osteoarthritis.
The histologic features observed in our series—nonspecific severe
degenerative changes with few marginal osteophytes and no evidence of primary
osteonecrosis, pannus formation, and crystal deposition—are similar to
those observed by previous authors
[1,
2,
7,
8]. Yamamoto and Bullough
[3] also described the presence
of granulomatous lesions in the bone marrow and suggested that such foci of
fragmented bone and articular cartilage debris were characteristic findings in
rapidly destructive hip osteoarthritis. In our series, histology did not show
evidence of these findings. This type of lesion, however, has been reported to
be especially prominent in the advanced stages of rapidly destructive hip
osteoarthritis [3].
The precise pathogenesis of rapidly destructive hip osteoarthritis remains
unclear. Direct drug toxicity and the analgesic effect of non-steroidal
antiinflammatory drugs, especially indomethacin, were first incriminated in
the development of rapidly destructive hip osteoarthritis (analgesic hip), but
their contributory effect was subsequently challenged in the literature
[5]. Some investigators
[2,
6,
9] implicated intraarticular
deposition of hydroxyapatite crystal as a cause for rapidly destructive hip
osteoarthritis. However, apatite deposition in rapidly destructive hip
osteoarthritis is a nonspecific and rare finding, and its presence in synovial
fluid as a primary or secondary factor in joint damage is still debated.
Komiya et al. [11] found that
bone resorptive factors such as proteolytic enzymes and cytokines in joint
fluid could play a role in rapid chondrolysis. Recently, a proposed cause for
rapidly destructive hip osteoarthritis involved subchondral insufficiency
fracture of the femoral head
[3]. In this regard, the
presence of hypointense fracture lines in our study (four cases with
histologic confirmation in three) is noteworthy. However, if the concept of
subchondral fracture can explain joint destruction, the mechanism of rapid
chondrolysis in rapidly destructive hip osteoarthritis remains uncertain. Many
factors that may contribute to the disease should probably be considered.
Our study has two major limitations. First, it is a retrospective study
with an inherent selection bias. We believe our results merit reporting,
however, because the MR imaging findings of this uncommon condition have not
been published widely. A second shortcoming is that the pathologic examination
was available in only seven patients. In our series as in others
[1,
2,
8], we based our diagnoses on
accepted clinical and radiologic criteria that were correlated with histologic
findings by past investigators
[2,
8].
In summary, the diagnosis of rapidly destructive hip osteoarthritis
generally is based on a quick progression of hip pain and on radiographs
showing rapid chondrolysis. However, various causes of hip joint destruction
must be included in the differential diagnosis, especially in the initial
phase of rapidly destructive hip osteoarthritis; MR imaging can be valuable in
the evaluation of such disorders. Therefore, radiologists should be aware of
MR imaging findings in patients with rapidly destructive hip osteoarthritis
that can overlap other diagnostic entities. The key MR imaging features
include an extensive bone marrow edemalike pattern in the femoral head and
neck, femoral head flattening, and cystlike subchondral defects. Additional
findings include epiphyseal low-signal-intensity lines, bandlike areas of low
signal intensity in the subchondral bone of the femoral head, and focal signal
abnormalities in the adjacent soft tissues on short tau inversion recovery,
fat-suppressed T2-weighted, or fat-suppressed gadolinium-enhanced T1-weighted
MR images.
Acknowledgments
We thank Marnix van Holsbeeck of Henry Ford Hospital, Detroit, MI, for
reviewing this manuscript.
References
- Lequesne M. Rapid destructive coxarthritis [in French].
Rhumatologie
1970;2:51
-63
- Bock GW, Garcia A, Weisman MH, et al. Rapidly destructive hip
disease: clinical and imaging abnormalities. Radiology
1993;186:461
-466[Abstract/Free Full Text]
- Yamamoto T, Bullough PG. The role of subchondral insufficiency
fracture in rapid destruction of the hip joint. Arthritis
Rheum 2000;43:2423
-2427[Medline]
- Mitchell DG, Rao V, Dalinka M, et al. MRI of joint fluid in the
normal and ischemic hip. AJR
1986;246:1215
-1218
- Postel M, Kerboull M. Total prosthetic replacement in rapidly
destructive arthrosis of the hip joint. Clin Orthop
1970;72:138
-144[Medline]
- Doherty M, Holt M, MacMillan P, Watt I, Dieppe P. A reappraisal of
"analgesic hip." Ann Rheum Dis
1986;45:272
-276[Abstract/Free Full Text]
- Depuyt F, Van Holsbeeck M. Rapidly destructive coxarthrosis: case
study and review of the literature [in Dutch]. J Belge
Radiol 1990;73:207
-210[Medline]
- Rosenberg ZS, Shankman S, Steiner GC, Kastenbaum DK, Norman A,
Lazansky MG. Rapid destructive osteoarthritis: clinical, radiographic, and
pathologic features. Radiology
1992;182:213
-216[Abstract/Free Full Text]
- Lawrance JAL, Athanasou NA. Rapidly destructive hip disease.
Skeletal Radiol
1995;24:639
-641[Medline]
- Zanetti M, Bruder E, Romero J, Hodler J. Bone marrow edema pattern
in osteoarthritic knees: correlation between MR imaging and histologic
findings. Radiology
2000;215:835
-840[Abstract/Free Full Text]
- Komiya S, Inoue A, Sasaguri Y, Minamitani K, Morimatsu M. Rapidly
destructive arthropathy of the hip: studies on bone resorptive factors in
joint fluid with a theory of pathogenesis. Clin Orthop
1992;284:273
-282
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Abstract
Introduction
