Serendipitous diagnosis of coxofemoral arthrosis complicating congenital hip dysplasia by CT
In the family history, a sister with implant of coxofemoral prosthesis at the age of 50. The patient has short stature and complains of hip pain since a few years, with walking difficulty rapidly worsening in the last months. Angio- CT scan was performed to rule out a vascular origin of walking difficulty. The iliac axis and the femoral arteries were free of stenosis, with stenosis at the bifurcation from common iliac to left external iliac artery. Most notably, angio-CT showed an obvious bilateral hips dysplasia with an evident upward and lateral displacement of the femoral head towards the iliac wings. The expanded neoacetabulum was thickened by a synovial reaction.
Developmental dysplasia of the hip (DDH) is the most common congenital musculoskeletal disorder in childhood and is characterized by varying displacement of the proximal femoral head from the poorly developed acetabulum. It can be clinically apparent at birth or after several months or years. The early recognition of the disease is important to prevent long-term structural alterations. In spite of the clinical warning signs, and availability of several imaging methods, the diagnosis can be missed at an early stage of life, when it is obvious, and can become challenging in an advanced age. In untreated cases, as the one discussed here, pain and residual disability due to osteoarthrosis may ensue even after the fifth decade of life, raising problems of differential diagnosis with arterial vascular disease as a cause of walking difficulty. Angio CT was performed in the presented case to rule out atherosclerotic vascular disease, which was excluded. However, the same exam serendipitously showed an obvious hip dysplasia unsuspected on clinical grounds. Of course CT is the preferred modality for assessment of osseous-based abnormalities of the hip. CT examinations are optimal for multiplanar and three-dimensional reconstructions.
Hip arthrosis as a complication of congenital dysplasia
This CT scan primarily focuses on the hip joint and surrounding structures. From axial, sagittal, and 3D reconstructed images, the following features are observed:
Based on the patient’s age (80 years old), background of occult acetabular dysplasia, and the CT findings, the following diagnoses are considered:
Combining the imaging results and medical history, the most likely consideration is “Congenital Dysplasia of the Hip with secondary osteoarthritis.”
Given the patient’s advanced age, typical signs of congenital abnormality (DDH), and evident degenerative (osteoarthritic) changes, the most likely final diagnosis is:
“Degenerative hip (femoral head-acetabular) changes secondary to congenital dysplasia of the hip.”
Given osteoarthritis arising from congenital dysplasia of the hip, a safe and gradual exercise regimen (following the FITT-VP principle) is recommended:
Regular follow-ups are necessary during rehabilitation. If severe joint pain, further functional decline, or other discomfort occurs, medical advice should be sought promptly to rule out complications.
This report is based solely on available imaging and provided history, and does not replace in-person consultation or professional medical advice. A definitive diagnosis and treatment plan require correlation with clinical symptoms, laboratory results, and specialized medical evaluation.
Hip arthrosis as a complication of congenital dysplasia
