Treatment of disorder
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medical treatment
Rapidly Destructive Coxopathy is the disease concept, first reported in France in 1960s, and broadly propounded by Postel M, et al in 1970. It has been considered as independent syndrome then, but now it is considered as generic term for the case of specific clinical course, simple X-ray image course.
This is a unknown cause of disease where, common among over 65 to 70 years old female who has no epidemic structural disorder or although having this structural disorder, hip joint which is just the very limited moderate acetabular dysplasia (roof of the hip joint is shallow) may breaks down within 6 months to one-year (joint space disappear, and disrupt femoral head/acetabulum).
The cause of primary disease of hip joint is unknown but a opinion says this is just one of type of primary disease of hip joint, but on the other hand, special type of osteonecrosis of femoral head or articular rheumatism, Subchondral insufficiency fracture, crystal deposition, idiopathic chondrolysis of the hip, or stress caused by pelvic inclination are considered. But the cause of this disease is still unknown till now.
Annual numbers of patient are estimated about 650, and it is considered that 25 % of them may develop coxalgia. It is presumed that this disease may appear more commonly among over 60s aged female, but according to Postel M., et al, it is said that the average age is 68 and female takes 80 to 90 %. Single side case is the common one but there are both side case with 10%.
Besides, the report says that participation of family history is negative and male/female ratio is 0.21, half of them are age 70s, male has a peak at 60s, among female almost same number exists in age 60s and 70s, approximately 80% are distributed in age 60s and 70s, and single side case is 87.3% and 2/3 of affected articulation are at right side.
Clinical symptom is aching pain exists from the early stage and increases with the advancement of acute bone breakdown. Severe coxalgia is complained but most of the case there is no major change is recognized in simple X-ray image. Impairment of ambulation or claudication becomes conspicuous due to severe coxalgia. Range of motion of hip joint is mostly kept maintained in comparison with normal last stage Coxopathy. And when bone breaks down, loss of bone head or pathologic dislocation by acetabular destruction are developed so that shortening of leg of patient may occur. Symptoms are getting worse in few months and it may accompany with pain at rest. Exercise pain is especially severe, ambulation is posed impairment so that impairment or limitation of daily life behavior becomes epidemic.
Main examination are as follows.
As a differential diagnosis, Idiopathic Osteonecrosis of Femoral Head, Articular Rheumatism, Neurotic Osteoarthritis (Charcot joint), Pyogenic arthritis, Tuberculous arthritis can be listed. There is no clear diagnosis standards for this disease. As a result, the case is diagnosed as this disease when destruction of hip joint has advanced within 6 to 12 months from the development.
Since it is developed among aged personnel and bone breakdown is advanced with femoral head or acetabular. As the treatment for this disease, hip replacement arthroplasty is selected. There exists the complicating disease risk generally for artificial hip joint. When preservation treatment is daringly selected, stick or wheel chair is used. When aching pain is strong, keep quiet in bed with internal use of non-steroid anti-inflammation drug (NSAIDs) or suppository. However, preservation treatment never cure the disease completely so that it is surely connected with decline of daily life activity.
There is no distinguished complication disease involved with Rapidly Destructive Coxarthropathy.
