Advertisement

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

  • Donald J. FlemmingEmail author
  • Cristy N. Gustas-French
Imaging (D Mintz, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Imaging

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.

Keywords

Rapidly Progressive Osteoarthritis Subchondral Fracture Chondrolysis Post-traumatic Arthritis 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

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

Supplementary material

11926_2017_665_MOESM1_ESM.jpg (326 kb)
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)
11926_2017_665_MOESM2_ESM.jpg (46 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)
11926_2017_665_MOESM3_ESM.jpg (34 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)
11926_2017_665_MOESM4_ESM.jpg (391 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)
11926_2017_665_MOESM5_ESM.jpg (345 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)
11926_2017_665_MOESM6_ESM.jpg (448 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)
11926_2017_665_MOESM7_ESM.jpg (510 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)
11926_2017_665_MOESM8_ESM.jpg (450 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)
11926_2017_665_MOESM9_ESM.jpg (384 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)
11926_2017_665_MOESM10_ESM.jpg (22 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)
11926_2017_665_MOESM11_ESM.jpg (22 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)
11926_2017_665_MOESM12_ESM.jpg (406 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)
11926_2017_665_MOESM13_ESM.jpg (356 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)

References

Recently published papers of particular interest have been highlighted as: • Of importance

  1. 1.
    Postel M, Kerboull M. Total prosthetic replacement in rapidly destructive arthrosis of the hip joint. Clin Orthop Relat Res. 1970;72:138–44.PubMedGoogle Scholar
  2. 2.
    Lawrance JA, Athanasou NA. Rapidly destructive hip disease. Skelet Radiol. 1995;24:639–41.CrossRefGoogle Scholar
  3. 3.
    Lequesne M, de Sèze S, Amouroux J. Rapidly destructive coxarthrosis. Rev Rhum Mal Osteoartic. 1970;37:721–33.PubMedGoogle Scholar
  4. 4.
    Rosenberg ZS, Shankman S, Steiner GC, Kastenbaum DK, Norman A, Lazansky MG. Rapid destructive osteoarthritis: clinical, radiographic, and pathologic features. Radiology. 1992;182:213–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Batra S, Batra M, McMurtrie A, Sinha AK. Rapidly destructive osteoarthritis of the hip joint: a case series. J Orthop Surg Res. 2008;3:3–6.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bock GW, Garcia A, Weisman MH, et al. Rapidly destructive hip disease: clinical and imaging abnormalities. Radiology. 1993;186:461–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Irwin LR, Roberts JA. Rapidly progressive osteoarthrosis of the hip. J Arthroplasty. 1998;13:642–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Torre Della P, Picuti G, Di Filippo P. Rapidly progressive osteoarthritis of the hip. Ital J Orthop Traumatol. 1987;13:187–200.Google Scholar
  9. 9.
    Seo GS, Dieudonne G, Mooney SA, Monu JU. Unexplained “massive osteolysis of femoral head” (MOFH) after acetabular fracture: occurrence and suggested pathoetiology. Acta Radiol. 2016:1–9.Google Scholar
  10. 10.
    • Ketapure AL, Sun JH, Sim GB, Chun JM, Jeon IH. Rapidly destructive arthrosis of the shoulder joints: radiographic, magnetic resonance imaging, and histopathologic findings. Journal of Shoulder and Elbow Surgery Elsevier Ltd. 2015;24:922–7. This is the largest and most recent collection of cases of rapidly destructive arthrosis that included MRI imaging CrossRefGoogle Scholar
  11. 11.
    Coste F, Laurent F, Benichou C. Coxarthrosis with lysis of the femor head (wearing coxarthrosis). Rev Rhum Mal Osteoartic. 1959;26:305–8.PubMedGoogle Scholar
  12. 12.
    Boutry N, Paul C, Leroy X, Fredoux D, Migaud H, Cotten A. Rapidly destructive osteoarthritis of the hip: MR imaging findings. AJR Am J Roentgenol. 2002;179:657–63.CrossRefPubMedGoogle Scholar
  13. 13.
    McCarty DJ, Halverson PB, Carrera GF, Brewer BJ, Kozin F. “Milwaukee shoulder”—association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. I Clinical aspects Arthritis Rheum. 1981;24:464–73.CrossRefPubMedGoogle Scholar
  14. 14.
    • Durcan L, Bolster F, Kavanagh EC, GM MC. The structural consequences of calcium crystal deposition. Rheum Dis Clin North Am Elsevier Inc. 2014;40:311–28. Good review of the recent literature on the impact of crystal deposition on inflammation and joint degeneration CrossRefGoogle Scholar
  15. 15.
    Pritzker KPH. Counterpoint: hydroxyapatite crystal deposition is not intimately involved in the pathogenesis and progression of human osteoarthritis. Curr Rheumatol Rep. 2009;11:148–53.CrossRefPubMedGoogle Scholar
  16. 16.
    McCarthy GM, Cheung HS. Point: hydroxyapatite crystal deposition is intimately involved in the pathogenesis and progression of human osteoarthritis. Curr Rheumatol Rep. 2009;11:141–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Mitrovic DR, Riera H. Synovial, articular cartilage and bone changes in rapidly destructive arthropathy (osteoarthritis) of the hip. Rheumatol Int. 1992;12:17–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Huskisson EC, Berry H, Gishen P, Jubb RW, Whitehead J. Effects of antiinflammatory drugs on the progression of osteoarthritis of the knee. LINK Study Group. Longitudinal Investigation of Nonsteroidal Antiinflammatory Drugs in Knee Osteoarthritis. J Rheumatol. 1995;22:1941–6.PubMedGoogle Scholar
  19. 19.
    Hochberg MC. Serious joint-related adverse events in randomized controlled trials of anti-nerve growth factor monoclonal antibodies. Osteoarthritis and Cartilage. Elsevier Ltd. 2015;23:S18–21.CrossRefGoogle Scholar
  20. 20.
    Villoutreix C, Pham T, Tubach F, Dougados M, Ayral X. Intraarticular glucocorticoid injections in rapidly destructive hip osteoarthritis. Joint Bone Spine. 2006;73:66–71.CrossRefPubMedGoogle Scholar
  21. 21.
    Yamamoto T, Bullough PG. The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary report. Arthritis Rheum. 2000;43:2423–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Watanabe W, Itoi E, Yamada S. Early MRI findings of rapidly destructive coxarthrosis. Skelet Radiol. 2001;31:35–8.CrossRefGoogle Scholar
  23. 23.
    Sugano N, Ohzono K, Nishii T, et al. Early MRI findings of rapidly destructive coxopathy. Magn Reson Imaging. 2001;19:47–50.CrossRefPubMedGoogle Scholar
  24. 24.
    Goshima K, Kitaoka K, Nakase J, Tsuchiya H. Case report rapid destruction of the humeral head caused by subchondral insufficiency fracture: a report of two cases. Case Reports in Orthopedics Hindawi Publishing Corporation. 2015;2015:1–5.CrossRefGoogle Scholar
  25. 25.
    Yoshikawa K, Tamai K, Yano Y, et al. Rapid destruction of the humeral head due to bone fragility: report of two cases. J Orthop Sci. 2014;19:354–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Tokuya S, Kusumi T, Yamamoto T, Sakurada S, Toh S. Subchondral insufficiency fracture of the humeral head and glenoid resulting in rapidly destructive arthrosis: a case report. J Shoulder Elb Surg. 2004;13:86–9.CrossRefGoogle Scholar
  27. 27.
    Barvencik F, Gebauer M, Beil FT, et al. Age- and sex-related changes of humeral head microarchitecture: histomorphometric analysis of 60 human specimens. J Orthop Res. 2009; 108.Google Scholar
  28. 28.
    Mesko JW. Rapidly progressive femoral head osteolysis. J Arthroplasty. 1993;8:541–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Solomon L, Schnitzler CM, Browett JP. Osteoarthritis of the hip: the patient behind the disease. Ann Rheum Dis. 1982;41:118–25.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Scanzello CR, Goldring SR. The role of synovitis in osteoarthritis pathogenesis. Bone. 2012;51:249–57.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    • Rahmati M, Mobasheri A, Mozafari M. Inflammatory mediators in osteoarthritis: a critical review of the state-of-the-art, current prospects, and future challenges. Bone Elsevier Inc. 2016;85:81–90. Thorough review of the current literature on the impact of inflammation on the development and progression of osteoarthritis Google Scholar
  32. 32.
    Berenbaum F. Osteoarthritis as an in. Osteoarthritis and Cartilage Elsevier Ltd. 2013;21:16–21.CrossRefGoogle Scholar
  33. 33.
    Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y. MRI evaluation of collapsed femoral heads in patients 60 years old or older: differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. AJR Am J Roentgenol. 2010;195:W63–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Nguyen VD. Rapid destructive arthritis of the shoulder. Skelet Radiol. 1996;25:107–12.CrossRefGoogle Scholar
  35. 35.
    Pivec R, Johnson AJ, Mont MA. Differentiation, diagnosis, and treatment of osteoarthritis, osteonecrosis, and rapidly progressive osteoarthritis. Harwin SF, editor. Orthopedics. 2013;36:118–25.CrossRefPubMedGoogle Scholar
  36. 36.
    Charrois O, Kahwaji A, Vastel L, Rosencher N, Courpied JP. Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis. Int Orthop Springer-Verlag. 2001;25:22–4.CrossRefGoogle Scholar
  37. 37.
    Peters KS, Doets HC. Midterm results of cementless total hip replacement in rapidly destructive arthropathy and a review of the literature. Hip Int. 2009;19:352–8.PubMedGoogle Scholar
  38. 38.
    Kuo A, Ezzet KA, Patil S, Colwell CW. Total hip arthroplasty in rapidly destructive osteoarthritis of the hip: a case series. HSS Jrnl. 2009;5:117–9.CrossRefGoogle Scholar
  39. 39.
    Kawai T, Tanaka C, Ikenaga M, Kanoe H, Okudaira S. Total hip arthroplasty using Kerboull-type acetabular reinforcement device for rapidly destructive coxarthrosis. Journal of Arthroplasty Elsevier Inc. 2010;25:432–6.CrossRefGoogle Scholar
  40. 40.
    Charrois O, Kahwaji A, Rhami M, Inoue K, Courpied JP. Outcome after total hip arthroplasty performed for rapidly progressive hip destruction. Rev Chir Orthop Reparatrice Appar Mot. 2002;88:236–44.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of RadiologyPenn State Milton S. Hershey Medical CenterHersheyUSA

Personalised recommendations