Case Report of Rapidly Destructive Osteoarthritis of the Hip following Multiple High-dose Intra-articular Steroid Injections.

INTRODUCTION: Rapidly destructive osteoarthritis (RDO) is a rare and severe form of joint degeneration with an unclear etiology. Recently, intra-articular corticosteroid injections, a common treatment for osteoarthritis, have been implicated as a potential iatrogenic cause. This case is important as it documents this phenomenon in an atypical patient demographic, strengthening the evidence for this serious adverse event.

CASE REPORT: A 55-year-old male with a history of mild-to-moderate left hip osteoarthritis received two fluoroscopically guided, high-dose intra-articular injections of 80 mg Kenalog 6 months apart. Following the second injection, he experienced a rapid and severe worsening of pain and functional limitation. Radiographs taken 6 months post-injection revealed complete joint space loss and significant femoral head collapse, consistent with RDO. The patient subsequently underwent a successful total hip arthroplasty.

CONCLUSION: This case strengthens the association between multiple, high-dose intra-articular steroid injections and the subsequent development of RDO. The clinical implication is that clinicians must be aware of and counsel patients on this potential severe adverse event, particularly when considering repeated high-dose injections as a management strategy for hip osteoarthritis.