May 16, 2023

Complications of late stage osteoarthritis. This is a case of a 72-year-old female patient with known hip OA who experienced marked aggravation of pain in the left hip over the last 4 weeks. In addition, patient has a long lasting history of non-specified rheumatic disease treated with steroids and biologics. A. Coronal PDw fat suppressed MRI shows diffuse full thickness cartilage loss at the femoral and acetabular surfaces (arrowheads) but very little osteophyte formation. This is a common finding in secondary, post-arthritic OA. In addition, there is marked bone marrow edema (asterisk) uncommon for “usual” OA. B. In the corresponding axial image we see an extensive subchondral fracture at the anterior aspect of the femoral head with subchondral delamination (arrows).C. In addition to anterior fracture (arrowhead) sagittal image shows an additional fracture at the superior-posterior aspect of the femoral head, also with signs of delamination (arrows).
This femoral head is in the process of articular collapse. Subchondral fractures are a complication of advanced OA, in this case potentially triggered also by long-standing steroid medication.