Abstract
Purpose
To describe the imaging and clinical features of rapid osteolysis of the femoral neck in an attempt to better understand this uncommon pathology.
Materials and methods
We retrospectively reviewed the files of 11 patients (six women and five men) aged 53–78 years diagnosed with rapid osteolysis of the femoral neck. Available imaging studies included radiographs, CT, MRI, and bone scintigraphy. Histopathological evaluations were available for seven cases.
Results
All patients presented with complaints of hip pain, six of whom had acute symptoms, while the rest had progressive symptoms and impairment. All but one case were found to have bone deposition in adjacent hip muscles. CT confirmed bone deposition in adjacent tissues and true osteolysis of the femoral neck with relative sparing of the articular surfaces. Bone scintigraphy and MRI were useful to exclude underlying neoplastic disease.
Conclusions
Rapid osteolysis of the femoral neck tends to occur in patients with underlying comorbidities leading to bone fragility and may actually represent a peculiar form of spontaneous insufficiency fracture. Recognition of its imaging features and clinical risk factors may help distinguish this process from other more concerning disorders such as infection or neoplasm.
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References
Hall FM et al. Post-traumatic osteolysis of the pubic bone simulating a malignant lesion. J Bone Joint Surg Am. 1984;66(1):121–6.
Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Joint Surg Am. 1982;64(7):1053–8.
Daffner RH, Pavlov H. Stress fractures: current concepts. AJR. 1992;159(2):245–52.
Lambiase RE, Levine SM, Froehlich JA. Rapid osteolysis of the femoral neck after fracture. AJR. 1999;172(2):489–91.
Roback DL. Posttraumatic osteolysis of the femoral neck. AJR. 1980;134(6):1243–4.
Pope Jr TL et al. Pseudopathologic fracture of the femoral neck. Skeletal Radiol. 1981;7(2):129–30.
Newberg AH. Posttraumatic osteolysis vs. fracture. AJR. 1980;135(6):1317–8.
Schwappach JR et al. Subcapital fractures of the femoral neck: prevalence and cause of radiographic appearance simulating pathologic fracture. AJR. 1994;162(3):651–4.
Keschner MT et al. Pseudopathologic fracture of the neck of the femur. A case report. J Bone Joint Surg Am. 2004;86-A(7):1534–7.
Gorham LW, Stout AP. Massive osteolysis (acute spontaneous absorption of bone, phantom bone, disappearing bone); its relation to hemangiomatosis. J Bone Joint Surg Am. 1955;37-A(5):985–1004.
Hardegger F, Simpson LA, Segmueller G. The syndrome of idiopathic osteolysis. Classification, review, and case report. J Bone Joint Surg Br. 1985;67(1):88–93.
Richards AJ, Hamilton EB. Destructive arthropathy in chondrocalcinosis articularis. Ann Rheum Dis. 1974;33(3):196–203.
Boutry N et al. Rapidly destructive osteoarthritis of the hip: MR imaging findings. AJR. 2002;179(3):657–63.
Doherty M et al. A reappraisal of ‘analgesic hip’. Ann Rheum Dis. 1986;45(4):272–6.
Charran AK et al. Destructive discovertebral degenerative disease of the lumbar spine. Skeletal Radiol. 2012;41(10):1213–21.
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.
Yamamoto T, Bullough PG. Subchondral insufficiency fracture of the femoral head and medial femoral condyle. Skeletal Radiol. 2000;29(1):40–4.
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Blain-Paré, E., Ehlinger, M., Dosch, JC. et al. Rapid osteolysis of the femoral neck: consequence of an insufficiency fracture of the hip?. Skeletal Radiol 42, 1089–1095 (2013). https://doi.org/10.1007/s00256-013-1622-7
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DOI: https://doi.org/10.1007/s00256-013-1622-7