Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis in a Patient with Severe Platelet Deficiency due to Liver Cirrhosis and Immune Thrombocytopenic Purpura

Abstract

Rapidly destructive coxarthrosis (RDC) causes rapid and extreme destruction of the hip joint, which was reported by Postel and Kerboull. RDC is commonly unilateral and occurs mostly in elderly women. Immune thrombocytopenic purpura (ITP) is characterized by a low platelet count that is the result of both immune-mediated platelet destruction and suppression of platelet production. In patients with ITP undergoing surgery, bleeding associated with a low preoperative platelet count can lead to unsuccessful outcomes. To the best of our knowledge, there has been only one report describing total hip arthroplasty (THA) for patients with ITP and there have been no reports of THA for RDC with a very low platelet count due to liver cirrhosis (LC) and ITP. We report the case of a patient who had right RDC and a very low platelet count due to LC and ITP in whom THA was successfully performed. Furthermore, this case was also unique in that her platelet count increased after THA. THA for right RDC might resolve ITP by relieving inflammation of the right hip since her platelet count recovered after THA.

The mysteries of rapidly destructive arthrosis of the hip joint: a systemic literature review

“…Several potential risk factors have been proposed in the literature, including: (I) ageing; (II) female gender; (III) underlying health problems such as rheumatoid arthritis, diabetes mellitus and systemic lupus erythematosus; (IV) lower bone mineral density; (V) higher BMI; (VI) medicinal drug use including NSAIDs and corticosteroid; (VII) alcoholism (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(19)(20)(21)(22)(23)(24)27,29). In this study, we evaluated the risk factors and found the only prevalent factors were: (I) age greater than 60 years; (II) female gender; (III) underlying systemic disease such as rheumatoid arthritis, diabetes mellitus or systemic lupus erythematosus (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(19)(20)(21)23,24). There is insufficient evidence to support the relationship between BMD, BMI, medication and alcoholism and the o...…”

“…Yuasa et al reported that after an average follow-up duration of 9.3 years, the mean Harris Hip Score improved from 38.3 to 81.1 in RDA patients and from 43.6 to 84.2 in conventional osteoarthritis controls (15). During surgery, the total blood loss of patients with hip osteoarthritis was significantly less than patients with RDA (9,14,16,35). Sex, age and extra body weight (BMI) had no significant effect on bleeding (14)(15)(16).…”

“…All of these studies were retrospective. Fourteen were reported in Asia (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), six in Europe (16)(17)(18)(19)(20)(21) and three in America (22)(23)(24). In total, 17 detailed patient cases were included (one article reported two cases, see Table 1).…”

“…A total of 17 cases included the pain and limitations reported by patients suffering from RDA. Because of the intractable severity of pain, two patients underwent a total hip replacement (2,9). Twelve patients were reported to have 38.3±3.07 (range, [33][34][35][36][37][38][39][40][41][42] points in the Harris Hip Score (15).…”

“…Two patients used hydroxychloroquine and methotrexate for rheumatoid arthritis. One used thrombopoietin receptor agonist and Kenketsu Glovenin-I for immune thrombocytopenic purpura (9).…”