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Orthopedic Surgery Disease:Rapidly Destructive Coxopathy

Hip joint will break down within one-year period.

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).

Aged female takes 80 to 90 %.

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.

Pain may increase with the progression of bone breakdown

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.

Diagnose with comprehensive judgement.

Main examination are as follows.

Blood Test
Normally. no abnormality is found at blood test but there may be a case where slight elevation of inflammation reaction (CRP elevation) is recognized.
Simple X-ray examination
At the time of development, there is no problems other than the observation of primary disease of hip joint or Osteoporosis, or mild acetabular dysplasia. Observation of acetabular dysplasia is recognized with 69%, and joint space becomes narrower and breakdown of femoral head advance so that 2/3 to 1/2 of femoral head may disappear within one-year course.
Regarding the difference with normal disease of hip joint, there is a case accompanying with mild curing image at load area, but there recognizes no change of bone proliferation like formation of osteophytes.
It is difficult to make confirmed diagnosis at early development stage by only simple X-ray image, but there is a report saying MRI is useful.
Whilst a report says that MRI is useful, there is no established MRI observation which is characteristic for this disease. At early stage of disease development, signal strength abnormality appears at subchondral of the femoral head so that bone marrow edema is recognized from femoral head to cervical region with low brightness by T1 enhanced image and high brightness by T2 enhanced image. In case when this disease is suspicious, careful examination of MRI shall be performed and necessary to pursue its course carefully.
Bone scintigraphy
Hot up-take is recognized at bone head and acetabulum in bone scintigraphy.

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.

Treated by hip replacement arthroplasty.

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.

Latest Orthopaedic Surgery Outline, Rev.16, Pelvic and Coxa, Section 8: Diseases on Hip Joint, Rapidly Destructive Coxarthropathy, Author: Nakayama: 2006, 286-290
Text for Orthopedic surgeon, Rev. 15, Disease on Pelvic and Coxa II-A-2,Nankodo Publishing; 2010, 20-724
Hip surgery, Chapter 10 Other Diseases 3. Rapidly Destructive Coxarthropathy, Kinhodo; 2014, 851-853
Postel M, Kerboull M. Total prosthetic replacement in rapidly destructive arthrosis of the hip joint. Clin Orthop Relat Res. 1970 Sep-Oct;72:138-44.
Setsuko Takeshita,, National Survey Outcome for Rapidly Destructive Coxarthropathy, Designated Disease Research Report 1998, Health & Welfare Ministry, Bone & Joint Investigation and Research Group; 1998, 178-181
Kenji Ozono,, Case Amassment and Analysis for Rapidly Destructive Coxarthropathy (RDC) (Interim Report), Designated Disease Research Report 1997, Health & Welfare Ministry, Bone & Joint Investigation and Research Group; 1998, 118-119
Shin Yamada,, Examination of MRI Observation in the process of joint fracture progression of Rapidly Destructive Coxarthropathy (RDC), 8. Hip Joint;2000, 26, 137-141
Sugano N, Ohzono K, Nishii T, Sakai T, Haraguchi K, Yoshikawa H, Kubo T. Early MRI findings of rapidly destructive coxopathy. Magn Reson Imaging. 2001 Jan;19(1):47-50.
Hiroyuki Hamaguchi, Early stage MRI Observation in Rapidly Destructive Coxarthropathy, Hip Joint;2004, 30, 378-381