Rapidly Progressive Osteoarthritis of the Hip Secondary to a Subchondral Insufficiency Fracture of the Acetabulum: A Case Report

  • Carlos Martín Lucero Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina) https://orcid.org/0000-0002-0833-7818
  • Fernando Díaz Dilernia Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina) https://orcid.org/0000-0002-7830-2207
  • Gerardo Zanotti Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina) https://orcid.org/0000-0001-8090-4832
  • Fernando Comba Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina) https://orcid.org/0000-0002-2848-2983
  • Francisco Piccaluga Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina) https://orcid.org/0000-0002-9887-4886
  • Martín Buttaro Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina) https://orcid.org/0000-0003-3329-778X
Keywords: Insufficiency fracture, acetabulum, total hip arthroplasty

Abstract

Subchondral insufficiency fractures are a rare cause of hip pain. Unlike acute traumatic fractures, acetabulum insufficiency fractures are less common than femoral fractures. They commonly occur in postmenopausal women with comorbidities. Its initial diagnosis is usually difficult and clinical suspicion is of great importance. Magnetic resonance imaging (MRI) is a fundamental tool for the detection of this pathology. Underestimating these injuries can lead to the development of rapidly progressive osteoarthritis and joint replacement as an outcome. We present the case of a 68-year-old patient with a subchondral insufficiency fracture of the acetabulum who underwent uncemented total hip arthroplasty.

Downloads

Download data is not yet available.

Author Biographies

Carlos Martín Lucero, Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”,Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Fernando Díaz Dilernia, Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”,Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Gerardo Zanotti, Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”,Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Fernando Comba, Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Francisco Piccaluga, Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”,Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Martín Buttaro, Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)
Hip Center“Sir John Charnley”, Orthopedics and Traumatology Institute “Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)

References

Kawano K, Motomura G, Ikemura S, Kubo Y, Hatanaka H, Utsunomiya T, et al. Subchondral insufficiency fracture of the femoral head in an elderly woman with symptomatic osteoarthritis of the contralateral hip. J Orthop Sci 2018;S0949-2658(18)30043-5. hppts://doi.org/10.1016/j.jos.2018.02.001

Kimura T, Goto T, Hamada D, Tsutsui T, Wada K, Fukuta S, et al. Subchondral insufficiency fracture of the femoral head caused by excessive lateralization of the acetabular rim. Case Rep Orthop 2016;2016:4371679.

https://doi.org/10.1155/2016/4371679

Hackney LA, Lee MH, Joseph GB, Vail TP, Link TM. Subchondral insufficiency fractures of the femoral head:

associated imaging findings and predictors of clinical progression. Eur Radiol 2016;26(6):1929-41. https://doi.org/10.1007/s00330-015-3967-x

Yamamoto T, Bullough PG. The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a

preliminary report. Arthritis Rheum 2000;43(11):2423-7. https://doi.org/10.1002/1529-0131(200011)43:11<2423::AID-ANR8>3.0.CO;2-Z

Jauregui JJ, Clayton A, Kapadia BH, Cherian JJ, Issa K, Mont MA. Total hip arthroplasty for acute acetabular

fractures: a review of the literature. Expert Rev Med Devices 2015;12(3):287-95.

https://doi.org/10.1586/17434440.2015.1009828

Pentecost RL, Murray RA, Brindley HH. Fatigue, insufficiency, and pathologic fractures. JAMA 1964;28(187):1001-4. https://doi.org/10.1001/jama.1964.03060260029006

Sakamoto A, Yamamoto T, Tanaka K, Matsuda S, Yoshida T, Iwamoto Y. Insufficiency fracture in the paraacetabulum, with features mimicking those of a malignant bone tumor. Clin Med Case Rep 2008;1:73-6.

https://doi.org/10.4137/ccrep.s803

Brennan M, O’Shea PM, O’Keeffe ST, Mulkerrin EC. Spontaneous insufficiency fractures. J Nutr Health Aging

;23(8):758-60. https://doi.org/10.1007/s12603-019-1234-6

Wearing SC, Hennig EM, Byrne NM, Steele JR, Hills AP. Musculoskeletal disorders associated with obesity: a

biomechanical perspective. Obes Rev 2006;7(3):239-50. https://doi.org/10.1111/j.1467-789X.2006.00251.x

Schachter AK, Roberts CS, Seligson D. Occult bilateral acetabular fractures associated with high-energy trauma and osteoporosis. J Orthop Trauma 2003;17(5):386-9. https://doi.org/10.1097/00005131-200305000-00012

Watarai K, Taneda H, Higano M, Hirasawa Y, Oda H. Rapidly destructive arthrosis of the hip joint after insufficiency fracture of the acetabulum. J Orthop Sci 2008;13(6):561-5. https:/doi.org/10.1007/s00776-008-1261-3

Angles F, Coscujuela A, Tramunt C, Panisello MG, Portabella F. Complication of an insufficiency fracture of the

acetabulum. Hip Int 2008;18(3):236-8. https://doi.org/10.5301/hip.2008.2237

Ikemura S, Mawatari T, Matsui G, Iguchi T, Mitsuyasu H. Clinical outcomes in relation to locations of bone marrow edema lesions in patients with a subchondral insufficiency fracture of the hip: a review of fifteen cases. Br J Radiol 2016;89(1066):20150750. https://doi.org/10.1259/bjr.20150750

Buttaro M, Della Valle AG, Morandi A, Sabas M, Pietrani M, Piccaluga F. Insufficiency subchondral fracture of the femoral head: report of 4 cases and review of the literature. J Arthroplasty 2003;18(3):377-82.

https://doi.org/10.1054/arth.2003.50092

Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal

femur. AJR Am J Roentgenol 2008;191(4):995-1001. https://doi.org/10.2214/AJR.07.3714

Guerado E, Cano JR, Cruz E. Occult acetabular fracture in elderly patients. Open Orthop J 2012;6:582-6.

https://doi.org/10.2174/1874325001206010582

Jo WL, Lee WS, Chae DS, Yang IH, Lee KM, Koo KH. Decreased lumbar lordosis and deficient acetabular coverage are risk factors for subchondral insufficiency fracture. J Korean Med Sci 2016;31(10):1650-5.

https://doi.org/10.3346/jkms.2016.31.10.1650

Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg 1999;7(2):128-41. https://doi.org/10.5435/00124635-199903000-00006

Bangil M, Soubrier M, Dubost JJ, Rami S, Carcanagues Y, Ristori JM, et al. Subchondral insufficiency fracture of

the femoral head. Rev Rheum Engl Ed 1996;63(11):85-61. PMID: 9010975

Lopez Viana S, Machado BB, Mendlovitz PS. MRI of subchondral fractures: a review. Skeletal Radiol 2014;43(11):1515-27. https://doi.org/10.1007/s00256-014-1946-y

Published
2021-04-14
How to Cite
Lucero, C. M., Díaz Dilernia, F., Zanotti, G., Comba, F., Piccaluga, F., & Buttaro, M. (2021). Rapidly Progressive Osteoarthritis of the Hip Secondary to a Subchondral Insufficiency Fracture of the Acetabulum: A Case Report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(2), 228-234. https://doi.org/10.15417/issn.1852-7434.2021.86.2.1090
Section
Case Presentations