Abstract
Background
Neuropathic arthropathy is characterized by rapidly progressive bone destruction in the setting of impaired nociceptive and proprioceptive innervation to the involved joint. It is seen most commonly in the foot and ankle, secondary to peripheral neuropathy in patients with diabetes mellitus. Other less common sites of involvement may include the knee, hip, shoulder, and spine, depending on the underlying etiology. Neuropathic arthropathy can be associated with tabes dorsalis, a unique manifestation of late, tertiary neurosyphilis that may arise in individuals with untreated syphilis many years after initial infection, and usually involves the knee, or less commonly, the hip.
Case Report
We report the case of a 73-year-old man with neuropathic arthropathy of the hip and tabes dorsalis attributable to previously undiagnosed tertiary syphilis. There was considerable delay in the diagnosis and unnecessary diagnostic testing owing to failure to consider syphilis as the cause.
Literature Review
With the advent of effective antimicrobial therapy and public health campaigns, the relationship between untreated syphilis and neuropathic arthropathy has been primarily a historic point of interest. However, current epidemiologic research suggests a resurgence of syphilis in the United States, with an increased incidence of patients presenting with manifestations of tertiary syphilis from unidentified and untreated primary infections. Treatment options for neuropathic arthropathy of the hip are limited. Arthrodesis has had poor success and treatment with THA has had high complication rates.
Conclusions
Syphilis is not merely a historic cause of neuropathic arthropathy. Neurosyphilis and tabes dorsalis should be considered in the differential diagnosis for patients presenting with rapid joint destruction consistent with Charcot arthropathy and no other apparent cause.
References
Allali F, Rahmouni R, Hajjaj-Hassouni N. Tabetic arthropathy: a report of 43 cases. Clin Rheumatol. 2006;25:858–860.
Alpert SW, Koval KJ, Zuckerman JD. Neuropathic arthropathy: review of current knowledge. J Am Acad Orthop Surg. 1996;4:100–108.
Avimadje AM, Pellieux S, Goupille P, Zerkak D, Valat JP, Fouquet B. Destructive hip disease complicating traumatic paraplegia. Joint Bone Spine. 2000;67:334–336.
Bruckner FE, Howell A. Neuropathic joints. Semin Arthritis Rheum. 1972;2:47–69.
Centers for Disease Control and Prevention. Sexually transmitted diseases surveillance, 2007: syphilis. Available at: http://www.cdc.gov/std/stats07/syphilis.htm. Accessed May 14, 2009.
Charcot JM. Sur quelques arthropathies qui paraissent dépendre d’une lésion du cerveau ou de la moele épinière. Arch Physiol Norm Pathol. 1868;1:161–171.
Douglas JM Jr. Penicillin treatment of syphilis: clearing away the shadow on the land. JAMA. 2009;301;769–771.
Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA. 2003;290:1510–1514.
Gupta R. A short history of neuropathic arthropathy. Clin Orthop Relat Res. 1993;296:43–49.
Jones EA, Manaster BJ, May DA, Disler DG. Neuropathic osteoarthropathy: diagnostic dilemmas and differential diagnosis. Radiographics. 2000;20:S279–S293.
Parvizi J, Marrs J, Morrey BF. Total knee arthroplasty for neuropathic (Charcot) joints. Clin Orthop Relat Res. 2003;416:145–150.
Rapala K, Obrebski M. Charcot’s arthropathy of the hip joints: a late manifestation of tabes dorsalis successfully treated by total joint arthroplasty: report of 2 cases. J Arthroplasty. 2007;22:771–774.
Robb JE, Rymaszewski LA, Reeves BF, Lacey CJ. Total hip replacement in a Charcot joint: brief report. J Bone Joint Surg Br. 1988;70:489.
Sprenger TR, Foley CJ. Hip replacement in a Charcot joint: a case report and historical review. Clin Orthop Relat Res. 1982;165:191–194.
Storey G. Charcot joints. Br J Vener Dis. 1964;40:109–117.
Acknowledgments
We thank Leslie G. Dodd, MD, of the Division of Soft Tissue and Bone Pathology at Duke University Medical Center for contributions with the histologic analyses in this report. We also thank Salutario Martinez, MD, of the Division of Musculoskeletal Imaging at Duke University Medical Center for input in the radiographic imaging studies presented in this report.
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution either has waived or does not require approval for the reporting of this case, that all investigations were conducted in conformity with ethical principles of research, and informed consent was obtained for participation.
About this article
Cite this article
Viens, N.A., Watters, T.S., Vinson, E.N. et al. Case Report: Neuropathic Arthropathy of the Hip as a Sequela of Undiagnosed Tertiary Syphilis. Clin Orthop Relat Res 468, 3126–3131 (2010). https://doi.org/10.1007/s11999-010-1257-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-010-1257-0