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Updated: Oct 20, 2025
Imaging of the Microstructural Failure Mechanism in the Human Hip
Published on: September 29, 2023
Destructive Arthropathy of the Femoral Head
Lester J Layfield1, Julia R Crim2
1Department of Pathology and Anatomical Sciences, Columbia, MO, USA.
Insights
Destructive hip arthropathy causes significant femoral head bone loss without infection. Histologic findings reveal distinct fibromyxoid changes and increased osteoclast activity, suggesting a cascade of tissue factors initiate bone destruction.
Area of Science:
- Orthopedics
- Pathology
Background:
- Destructive arthropathy of the hip is a poorly defined condition characterized by noninfectious, extensive femoral head bone destruction.
- Existing diagnostic criteria are varied, leading to ambiguity in its definition and study.
Purpose of the Study:
- To define the clinicopathologic features of destructive hip arthropathy.
- To identify characteristic imaging and histological findings associated with this condition.
Main Methods:
- Retrospective review of 20 cases diagnosed with destructive arthropathy between July 2015 and December 2019.
- Analysis of clinical presentation, laboratory values, imaging studies, and pathological diagnoses.
- Detailed review of imaging studies and pathology specimens.
Main Results:
- Twenty femoral heads exhibited ≥25% destruction without infection, congenital disease, or inflammatory arthritis.
- Pathological findings included fibromyxoid marrow changes, necrotic bone fragments, increased osteoclasts, trabecular destruction, and granuloma-like aggregates.
- These histologic features were found to be distinctive.
Conclusions:
- The distinct histologic findings suggest a unique pathological process in destructive hip arthropathy.
- A cascade of tissue factors, potentially triggered by various pre-existing conditions, is postulated to cause the observed bone destruction.
Objectives:
Destructive arthropathy of the hip refers to noninfectious arthropathy causing extensive femoral head bone destruction. It has been described in the surgical literature using a variety of diagnostic criteria, but it remains a poorly defined entity.
Methods:
Cases of destructive arthropathy diagnosed at our institution between July 1, 2015, and December 31, 2019, were identified by a free text search of the radiology database. The medical record of each case was reviewed for possible causes of femoral head destruction, clinical presentation, laboratory values, imaging studies, and pathologic diagnoses. Imaging studies and pathology specimens were retrospectively reviewed.
Results:
Twenty femoral heads were identified in which there was 25% or greater destruction of the femoral head in the absence of infections, congenital disease, or inflammatory arthritis. Destructive arthropathy was characterized pathologically by fibromyxoid change of the marrow, aggregates of necrotic bone fragments, increased numbers of osteoclasts, increased trabecular destruction, and granuloma-like aggregates.
Conclusions:
The histologic findings were distinctive. We postulate that a variety of preexisting conditions set in motion a cascade of tissue factors that led to bone destruction.
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