What Is Rapidly Destructive Hip Disease?
The rapidly destructive hip disease is a disorder characterized by rapid degeneration and destruction of the joints. The process is the result of rapid degeneration of the joint of the hip that usually occurs within months of the development of signs and symptoms. It is also associated with instability and malfunctioning of the joint. Forestier first described the disease in 1957. It is a rare disorder affecting the head of the femoral bone and acetabulum. The rapidly destructive hip disorder is a very rare syndrome of unknown cause. It is important to differentiate it from ischaemic necrosis of the femoral head. Here, it results in rapid destruction and deterioration of both the femoral and acetabular surfaces of the hip joint leading to the progressive fading of the femoral head. The disease is also known as:
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Rapidly progressive osteoarthritis of the hip (RPOH).
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Rapidly destructive arthritis.
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Rapidly destructive osteoarthritis.
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Rapidly destructive hip disease.
What Is the Etiology of Rapidly Destructive Hip Disease?
The etiology of the disease is not known completely. Still, some researchers suggest the role of administration of intraarticular corticosteroid injection, toxicity caused by the drugs, and immune-mediated reactions in the initiation of subchondral osteonecrosis, and ischemia in the joint of the hip.
What Is Intraarticular Glucocorticoid Injection?
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Intraarticular glucocorticosteroid injections are a group of steroid hormones that are directly injected into the arthritic joint space of a tender, painful, inflamed joint. Oral steroids (taken by mouth) are not used in the treatment of osteoarthritis. The shots are administered once every three months.
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Intraarticular glucocorticoid injection is a treatment modality considered when all the other conservative measures fail.
Why Is Intraarticular Glucocorticoid Injection Given in Hip Osteoarthritis?
Intra-articular glucocorticoid injection is given to alleviate tenderness and stiffness in the joint by directly delivering the medication into the joint space, thereby minimizing systemic side effects. However, intraarticular steroid injections should not be considered the mainstay treatment for hip osteoarthritis or other joint diseases. It can be used as an adjunct in association with other treatment options. Intraarticular glucocorticoid injections can provide short-term relief but the long-term effect of the corticosteroids on the joints is quite controversial.
What Is the Mechanism of Action of Intraarticular Glucocorticoid Injection?
Glucocorticoids have an anti-inflammatory effect. They are immunosuppressive drugs. Their mechanism of action is very complex. Corticosteroids interrupt the inflammatory and immune reactions at various levels by directly acting on the nuclear steroid receptors. Due to the anti-inflammatory actions of these drugs, they cause a generalized decrease in redness, swelling, pain, and warmth of the inflamed joints.
What Are the Complications of Intraarticular Glucocorticoid Injection?
The short-term complications of intraarticular glucocorticoids injections include:
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Septic arthritis (painful infection occurring in the joints due to the harmful germs that travel through the bloodstream).
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Pain at the injection site.
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Pigmentation of the skin.
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Atrophy of the overlying skin.
Is There a Link Between Rapidly Destructive Hip Disease and Intraarticular Glucocorticoid Injection?
There is an increase in the rate of occurrence of rapidly destructive hip disease after the administration of intraarticular glucocorticoid injection in patients suffering from hip osteoarthritis. Studies have been conducted by researchers that have successfully proven the correlation between intraarticular corticosteroid injection and the rapidly destructive hip disease.
What Are the Factors That Affect the Rate of Occurrence of Rapidly Destructive Hip Disease After Intraarticular Glucocorticoid Injection?
Scientists have identified the risk factors that increase the rate of the development of rapidly destructive hip disease after intraarticular glucocorticoid injection. These factors include:
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Injection Dose- The rate of occurrence of the rapidly destructive hip disease increases with an increase in the amount of injection dosage. Scientists have conducted a study and found out that people receiving a single low dose (≤40 milligrams) of Triamcinolone injection are at a lower risk of rapidly destructive hip disease. Whereas the risk is higher in patients receiving a high dose((≥80 milligrams) injection.
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Number of Injections Administered- The increase in the number of injections also increases the rate of occurrence of the rapidly destructive hip disease. Scientists have proven the higher risk of rapidly destructive hip disease following multiple injections administration in the patient.
What Is the Pathogenesis of Rapidly Destructive Hip Disease After Intraarticular Glucocorticoid Injection?
The intraarticular glucocorticoid injection is responsible for the initiation and rapid progression of some of the pathologic processes in hip osteoarthritic patients thereby leading to rapidly destructive hip disease. The injection causes rapid progression of-
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Narrowing of the joint space.
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Osteolysis (a process characterized by rapid destruction of the bone tissue).
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The collapse of the femoral head of the hip.
What Are the Risk Factors Associated With Rapidly Destructive Hip Disease After Intraarticular Glucocorticoid Injection?
According to researchers, the advanced age of the patient, joint space narrowed down to a greater extent, and osteoarthritis to a more severe level are a few risk factors that are associated with the development of rapidly destructive hip disease after intraarticular glucocorticoid injection.
What Precautions Should Be Taken With Intraarticular Glucocorticoid Injections in Hip Osteoarthritis Patients?
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Hip osteoarthritis patients should be counseled about the risks and complications that are associated with the standard procedure of intraarticular glucocorticoid injection.
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Caution should be taken at the time of the administration of intraarticular hip injections that involve a corticosteroid dosage of greater than or equal to 80 milligrams and administering multiple injections because that will increase the risk of rapidly destructive hip disease.
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Administration of high-dose corticosteroid injections should be stopped.
Conclusion:
Corticosteroid injections have been frequently used to reduce pain and inflammation in hip osteoarthritis patients but scientists have raised concerns over their long-term usage and potentially harmful effects. It is suggested that the risk of developing the rapidly destructive hip disease is higher in individuals who are receiving high doses of corticosteroid injections and multiple injections. Therefore, caution should be taken while administering the injection in the joint space. There should not be an inadvertent use of corticosteroid injections. Patients should also be counseled about the side effects of these injections. Also, care should be taken while injecting corticosteroid injections in the intra-articular hip space utilizing more than or equal to 80 milligrams of corticosteroid and multiple injections.
