Total hip arthroplasty in rapidly destructive osteoarthritis of the hip: a case series

Rapidly destructive osteoarthritis (RDO) of the hip is a rare condition characterized by rapid joint degeneration and destruction similar to findings of infection, osteonecrosis, or Charcot disease but without a definitive diagnosis. The cause and natural history of RDO are unclear, but total hip arthroplasty has been utilized as a treatment modality due to the severity of the symptoms. We reviewed retrospectively the records of total hip arthroplasties performed between 1990 and 2003 and identified ten hips in eight patients who fit the profile of the diagnosis of RDO. The mean age at time of surgery was 70. Nine hips were treated with total hip arthroplasty with a hybrid configuration; one hip was treated with a non-cemented total hip arthroplasty. Average follow-up was 6 years with no radiographic evidence of acetabular loosening or osteolysis and no evidence of asymmetric cup wear. One femoral component had evidence of loosening but has not been revised. RDO is an idiopathic condition with no single diagnostic laboratory, pathological, or radiographic finding. A complete preoperative work-up for other causes of hip disease prior to arthroplasty for suspected RDO is necessary to rule out treatable disease. Our series of patients with RDO responded well to hybrid and non-cemented total hip arthroplasty with good clinical and radiographic results.