Elsevier

The Journal of Arthroplasty

Volume 21, Issue 7, October 2006, Pages 1026-1031
The Journal of Arthroplasty

Original Article
Outcome of the Contralateral Hip in Rapidly Destructive Arthrosis After Total Hip Arthroplasty: A Preliminary Report

https://doi.org/10.1016/j.arth.2005.08.007Get rights and content

Abstract

We investigated the outcome of the contralateral hip in patients with rapidly destructive arthrosis of the hip after total hip arthroplasty. Twenty-four patients were included, and the mean duration of radiographic follow-up was 7.0 years (range, 3.8-17.8 years). To assess the capable parameters for predicting the development of osteoarthritis, we evaluated the receiver operating characteristic curves. Three (12.5%) of 24 patients developed osteoarthritis and underwent total hip arthroplasty within 3.8 to 6.5 years. In these 3 patients, both the acetabular-head index and the center-edge angle were significantly lower than those in patients without osteoarthritis (P < .005). Based on the receiver operating characteristic curves, both an acetabular-head index of less than 72% and a center-edge angle of less than 16° were considered to be associated with the development of osteoarthritis.

Section snippets

Patients

Between January 1986 and December 1999, 27 patients underwent THA in our institution based on the previously reported criteria of RDA 1, 2, 3, 5: a clinical history of hip pain of 1 to 6 months' duration, a radiographic appearance of rapid joint space narrowing (>2 mm in 1 year or 50% joint space narrowing in 1 year) and progression of bone destruction involving the femoral head and the acetabulum with minimal osteophyte formation, and the absence of clinical or laboratory evidence of sepsis

Results

Twenty-four of 27 patients were followed (follow-up rate, 89%). Two cases died and one case dropped out. They consisted of 8 males and 16 females. The mean age at the initial THA for RDA was 71.0 years (range, 52-88 years). The mean duration of radiographic follow-up was 7.0 years (range, 3.8-17.8 years). The contralateral side at the time of initial THA was right in 8 and left in 16.

Three (12.5%) of 24 patients developed contralateral hip osteoarthritis during the course of this study, whereas

Discussion

Based on a study of patients with osteoarthritis, Ritter et al [7] reported that the probability of developing osteoarthritis in the contralateral hip after THA was 36.5% at 10 years. In our series, 3 (12.5%) of 24 patients with RDA developed osteoarthritis in the contralateral hip. This result suggests that patients with RDA may not have a higher risk of developing osteoarthritis in the contralateral hip after THA than patients with osteoarthritis.

In our series, one of 3 patients demonstrated

Acknowledgment

This work is supported in part by a Grant-in-Aid in Scientific Research (No. 15591587) from JSPS and a grant from Uehara Memorial Foundation.

We would like to thank Naoko Kinukawa (Department of Medical Informatics, Kyushu University, Fukuoka, Japan) for her helpful advice on the statistical analysis.

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    However, the pathophysiology and etiology of RDA remain unknown. Some studies proposed the following criteria for the diagnosis of RDA: a clinical history of hip pain of 1–6 months’ duration, a radiographic appearance of rapid joint space narrowing (>2 mm or 50% joint space narrowing in 1 year), progression of bone destruction involving the femoral head and the acetabulum with minimal osteophyte formation, and the absence of clinical or laboratory evidence of sepsis and neurological disease [10,11]. However, the standard diagnostic criteria for RDA remain unclear.

  • A case of rapidly destructive osteoarthritis of the hip with onset of less than six weeks

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    However, it seems to affect more elderly females. Some authors have proposed that alterations such as inversion of the acetabular labrum,3 a posterior tilt of the pelvis4 and mechanical abnormalities of the hip5 may possibly trigger RDOA. Other authors believe that this pathology can be explained by the coexistence of rapidly developing chondrolysis and poor bone stock leading to subchondral bone fractures.1–3

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This work is supported in part by a Grant-in-Aid in Scientific Research (No. 15591587) from JSPS and a grant from Uehara Memorial Foundation.

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