Hip Pelvis.  2018 Jun;30(2):115-119. 10.5371/hp.2018.30.2.115.

Sequential Bilateral Rapid Destructive Inflammatory Coxarthrosis in a Patient with Human Immunodeficiency Virus

• Kim HJ
• Kim SS
• Kim SJ
• Lee KH

• KMID: 2412693
• DOI: http://doi.org/10.5371/hp.2018.30.2.115

Abstract

The diagnostic criteria for sequential rapidly destructive coxarthrosis remain unclear and this condition is rarely reported in patients with human immunodeficiency virus (HIV). Here, we report a case of an HIV-infected 73-year old female who experienced hip joint destruction. The patient was diagnosed with HIV in 2012 (at age 68 years) and began continuous treatment with nucleoside reverse transcriptase and protease inhibitors. Twenty-nine months after her HIV diagnosis, the patient experienced osteonecrosis of the right hip and underwent a total hip arthroplasty (THA). Twelve months post right-hip THA, X-ray results showed good outcomes. Eight months later (20 months post THA), however, osteolysis of the left femoral head was detected upon radiological exam and THA of the left hip was performed; chronic inflammation and fibrosis were identified in the resultant biopsy. Favorable results were obtained at 3 months after the second surgery.

Keyword

Femur head; Osteonecrosis; Rapidly destructive coxarthrosis; Human immunodeficiency virus

MeSH Terms

Arthroplasty, Replacement, Hip
Biopsy
Diagnosis
Female
Femur Head
Fibrosis
Head
Hip
Hip Joint
HIV*
Humans
Humans*
Inflammation
Osteoarthritis, Hip*
Osteolysis
Osteonecrosis
Protease Inhibitors
RNA-Directed DNA Polymerase
Protease Inhibitors
RNA-Directed DNA Polymerase

Figure

• 

  Fig. 1 Initial computed tomography (CT) images are intact; (A) coronal image, (B) axial image. After 8 months, CT images show that femoral head collapse and subchondral bone cysts are formed, (C) coronal image, (D) axial image.

• 

  Fig. 2 (A) Intraoperative image shows that femoral head was collapsed. (B) Anteroposterior view of X-ray image shows that right hip joint was changed with implant and right hip joint is intact. The implant was used by Bencox ID stem and cup (Corentec, Seoul, Korea). (C) The follow-up image after 8 months shows that right femoral head was replaced by implant and left femoral head was collapsed. (D) Removed soft tissue and femoral head show that inflammatory change.

• 

  Fig. 3 (A) The femur head shows diffuse destructive architecture with dense fibrotic change (H&E stain, ×40). (B) On high magnification, the bone is necrotic (left upper portion) and marrow space shows fibrosis and chronic inflammatory cells infiltration (right lower portion) (H&E stain, ×200).

• 

  Fig. 4 Anteroposterior view of after 3 months follow-up image shows implant fixation state.

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