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Ischemic necrosis of the entire femoral head and rapidly destructive hip disease: potential causative relationship

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Rapidly destructive hip disease (RDHD) is an uncommon disorder of the hip that has been considered a disease of unknown cause and distinct from isch-emic necrosis of the femoral head. The objective of this study was to investigate ischemic necrosis of the femoral head as one potential cause of RDHD.

Design and patients

In 600 patients who underwent MR imaging of the hip, 20 cases of ischemic necrosis involving the entire femoral head in 18 patients (3%) were retrospectively studied with routine radiography and MR imaging. All patients had surgically confirmed ischemic necrosis of the femoral head.

Results and conclusions

All patients showed rapid destruction of the femoral head on routine radiography and MR imaging as compared with the gradual onset of clinical symptoms. Plain radiographs showed several bone fragments at the inferomedial aspect of the femoral head (75%), acetabular erosions (55%), eccentric depression at the lateral articular surface of the femoral head conforming to the adjacent acetabulum (35%), and mild osteoarthritis (15%). Bone sclerosis was often present at sites of impaction between the femoral head and the acetabulum. MR imaging showed marked distention of the joint capsule in all cases. In 14 of 20 cases, the contents of the joint space showed predominantly low or inter-mediate signal intensity on T1- and T2-weighted images. Ischcmic necrosis involving the entire femoral head may represent one of the causes of RDHD.

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  1. Mitchell MD, Kundel HL, Steinberg ME, Kressel HY, Alavi A, Axel L. Avascular necrosis of the hip: comparison of MR, CT, and scintigraphy. AJR 1986; 147:67–71.

    Article  CAS  Google Scholar 

  2. Totty WG, Murphy WA, Ganz WI, Kumar B, Daum WJ, Siegel MA. Magnetic resonance imaging of the normal and ischemic femoral head. AJR 1984; 143:1273–1280.

    Article  CAS  Google Scholar 

  3. Thickman D, Axel L, Kressel HY, et al. Magnetic resonance imaging of avascular necrosis of the femoral head. Skeletal Radiol 1986; 15:133–140.

    Article  CAS  Google Scholar 

  4. Mitchell DG, Rao V, Dalinka M, et al. MRI of joint fluid in the normal and ischemic hip. AJR 1986; 146:1215–1218.

    Article  CAS  Google Scholar 

  5. Mitchell DG, Rao VM, Dalinka MK, et al. Femoral head avascular necrosis: correlation of MR imaging, radio-graphic staging, radionuclide imaging, and clinical findings. Radiology 1987; 162:709–715.

    Article  CAS  Google Scholar 

  6. Coleman BG, Kressel HY, Dalinka MK, Scheibler ML, Burk DL, Cohen EK. Radiographically negative avascular necrosis: detection with MR imaging. Radiology 1988; 168:525–528.

    Article  CAS  Google Scholar 

  7. Genez BM, Wilson MR, Houk RW, et al. Early osteonecrosis of the femoral head: detection in high-risk patients with MR imaging. Radiology 1988; 168:521–524.

    Article  CAS  Google Scholar 

  8. Takatori Y, Kokubo T, Ninomiya S, Nakamura S, Morimoto S, Kusaba I. Avascular necrosis of the femoral head: natural history and magnetic resonance imaging. J Bone Joint Surg Br 1993; 75:217–221.

    Article  CAS  Google Scholar 

  9. Rosenberg ZS, Shankman S, Steiner GC, Kastenbaum DK, Norman A, Lazansky MG. Rapid destructive osteoar-thritis: clinical, radiographic, and pathologic features. Radiology 1992; 182:213–216.

    Article  CAS  Google Scholar 

  10. Bock GW, Garcia A, Weisman MH, et al. Rapidly destructive hip disease: clinical and imaging abnormalities. Radiology 1993; 186:461–466.

    Article  CAS  Google Scholar 

  11. Lawrance JAL, Athanasou NA. Rapidly destructive hip disease. Skeletal Radiol 1995; 24:639–641.

    Article  CAS  Google Scholar 

  12. Mitrovic DR, Riera H. Synovial, articular cartilage and bone changes in rapidly destructive arthropathy (osteoar-thritis) of the hip. Rheumatol Int 1992; 12:17–22.

    Article  CAS  Google Scholar 

  13. Pattrick M, Doherty M. Rapidly destructive hip disease following ipsilateral hemiparesis: report of two cases. Ann Rheum Dis 1987; 46:477–481.

    Article  CAS  Google Scholar 

  14. Ficat RP. Idiopathic bone osteonecrosis of the femoral head: early diagnosis and treatment. J Bone Joint Surg Am 1985; 76:3–9.

    Article  Google Scholar 

  15. Lequesne M. La coxarthrose destructrice rapide. Rheumatologie 1970; 22:21–37.

    Google Scholar 

  16. Ronningen H, Langeland N. Indomethacin treatment in osteoarthritis of the hip joint. Acta Orthop Scand 1979; 50:169–174.

    Article  CAS  Google Scholar 

  17. Lequesne M, Amouroux J. La coxarthrose destructrice rapide. Presse Med 1970; 78:1435–1439.

    CAS  PubMed  Google Scholar 

  18. Lequesne M. Les coxopathies rapidement destructrices inattendues. Presse Med 1970; 78:1425–1426.

    CAS  PubMed  Google Scholar 

  19. Menkes CJ, Decraemere W, Postel M, Forest M. Chondrocalcinosis and rapid destruction of the hip. J Rheumatol 1985; 12:130–133.

    CAS  PubMed  Google Scholar 

  20. Lequesne M, Ray G. La coxopathie destructrice rapide idiopathique: étude etiologique prospective de 27 cas. Rev Rhum 1989; 56:115–119.

    CAS  PubMed  Google Scholar 

  21. Gerster JC. Les arthropathies destructrices. Rev Rhum 1990; 57:143–149.

    CAS  PubMed  Google Scholar 

  22. Dieppe PA, Doherty M, McFarlane DG, Hutton CW, Bradfield JW, Watt I. Apatite associated destructive arthritis. Br J Rheumatol 1984; 23:84–91.

    Article  CAS  Google Scholar 

  23. Doherty M, Holt M, MacMillan P, Watt I, Dieppe P. A reappraisal of analgesic hip. Ann Rheum Dis 1986; 45:272–276.

    Article  CAS  Google Scholar 

  24. Shimizu K, Moriya H, Akita T, Sakamoto M, Suguro T. Prediction of collapse with magnetic resonance imaging of avascular necrosis of the femoral head. J Bone Joint Surg Am 1994; 76:215–223.

    Article  CAS  Google Scholar 

  25. Glimcher MJ, Kenzora JE. The biology of osteonecrosis of the human femoral head and its clinical implications. III. Discussion of etiology and genesis of the pathological sequelae: comments on treatment. Clin Orthop 1979; 140:273–312.

    Google Scholar 

  26. Normal A, Robbins H, Milgram J. The acute neuropathic arthropathy: a rapid severely disorganizing form of arthritis. Radiology 1968; 90: 1159–1164.

    Article  Google Scholar 

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Ryu, K.N., Kim, E.J., Yoo, M.C. et al. Ischemic necrosis of the entire femoral head and rapidly destructive hip disease: potential causative relationship. Skeletal Radiol 26, 143–149 (1997).

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