Hip Pelvis.  2014 Sep;26(3):189-193. 10.5371/hp.2014.26.3.189.

Rapid Destruction of the Hip Joint Accompanied by an Enlarged Iliopsoas Bursa in a Healthy Man

• Kim JO
• Cho HM

• KMID: 2054184
• DOI: http://doi.org/10.5371/hp.2014.26.3.189

Abstract

Association between enlarged iliopsoas bursa and hip lesions such as osteoarthritis of the hip or femoral head necrosis is infrequently seen. Enlarged iliopsoas bursa with a rapidly destructive arthropathy is claimed to be seen only in patients with rheumatoid arthritis. In this paper, we report a patient with a rapidly destructive arthropathy accompanied by an enlarged iliopsoas bursa that has been misdiagnosed as an infection.

Keyword

Iiopsoas bursa; Rapidly destructive coxarthrosis

MeSH Terms

Arthritis, Rheumatoid
Head
Hip
Hip Joint*
Humans
Necrosis
Osteoarthritis

Figure

• 

  Fig. 1 (A) Anteroposterior radiograph of the lumbar spine in a 72-year-old male patient taken 3 months prior to admission that shows non-specific joint space narrowing of the hip joint. (B) Anteroposterior view of the hip obtained 3 months later that shows an almost total disappearance of the left femoral head and osteolysis of the pelvic side. (C, D) Axial and coronal T2 weighted images showing extensive bone destruction of the femoral head and the enlarged iliopsoas bursa connected to the left hip joint.

• 

  Fig. 2 (A) Histological specimen of the bursa demonstrating acute inflammatory response with many neutrophils (H&E staining; left: ×100, right: ×400). (B) Histological specimen of femoral head demonstrating necrosis of the subchondral bone combined with osteoclast and osteoblast (H&E staining; left: ×100, right ×400).

• 

  Fig. 3 Postoperative radiograph taken after PROSTALAC (prosthesis of antibiotic-loaded acrylic cement) insertion and drainage of the iliopsoas bursa.

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  Fig. 4 (A) Postoperative radiograph taken after total hip arthroplasty. (B) At 12 months after operation, the radiograph shows stable fixation of component without subsidence or changes in alignment.

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