Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Orthop Surg. 2022 Jun;14(6):1251-1259. doi: 10.1111/os.13300. Epub 2022 May 7.
Osteonecrosis of the femoral head (ONFH) is a multifactorial disease, and agnogenic ONFH, otherwise known as idiopathic ONFH, is rare in clinic. Idiopathic ONFH that exhibits severe necrosis and progresses extremely rapidly is called rapidly destructive hip disease (RDHD). RDHD greatly affects patients but is rarely reported in clinical practice and literature.
In this study, a 64-year-old male patient with complete collapse and necrosis of the right femoral head complicated with severe bone destruction at 10 months after left total hip arthroplasty (THA) was reported. The period from the intact structure of the right femoral head to the first discovery of its complete collapse, according to imaging results, was 7 months. The duration from the occurrence of symptoms in the right hip joint to the first discovery of complete collapse and necrosis of the femoral head was only 5 months. At present, the cause has not been determined based on medical history, symptoms, signs, imaging evaluation results, laboratory examination results, and pathological examination results, though it has been identified as severe idiopathic aseptic necrosis of the femoral head with rapid progression, or RDHD. Finally, right THA was performed, and a good outcome was observed in the patient at present.
As a rare hip joint disease, RDHD greatly influences the normal life of patients. RDHD of the contralateral side after unilateral THA is even scarcer. Left THA may be one of the important factors accelerating the necrosis of the right femoral head. Hopefully, with this case report, more attention will be paid to the contralateral hip joint in patients undergoing unilateral THA by clinicians and rehabilitation physicians, and a clinical reference will be provided for the research on RDHD.
股骨头坏死（ONFH）是一种多因素疾病，特发性 ONFH 又称特发性股骨头坏死，在临床上较为少见。特发性股骨头坏死表现为严重坏死且进展极快的称为快速进展性髋病（RDHD）。RDHD 严重影响患者，但在临床实践和文献中很少报道。
本研究报道了 1 例左侧全髋关节置换术（THA）后 10 个月出现右侧股骨头完全塌陷和坏死、伴有严重骨破坏的 64 岁男性患者。根据影像学结果，右侧股骨头完整结构到首次发现完全塌陷的时间为 7 个月。从右侧髋关节出现症状到首次发现股骨头完全塌陷和坏死的时间仅为 5 个月。目前，根据病史、症状、体征、影像学评估结果、实验室检查结果和病理检查结果，尚未确定病因，但已确定为严重特发性无菌性股骨头坏死伴快速进展，或 RDHD。最终，行右侧 THA，患者目前预后良好。
作为一种罕见的髋关节疾病，RDHD 严重影响患者的正常生活。单侧 THA 后对侧 RDHD 更为罕见。左侧 THA 可能是加速右侧股骨头坏死的重要因素之一。希望通过本病例报告，引起临床医生和康复医师对单侧 THA 患者对侧髋关节的关注，并为 RDHD 的研究提供临床参考。
