Early diagnosis and targeted intervention based on the pathogenesis of rapidly progressive osteoarthritis of the hip

Abstract

Early diagnosis of rapidly progressive osteoarthritis of the hip (RPOH) remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria. Current diagnostic criteria (chondrolysis > 2 mm/year) require follow-up for at least 12 months. This review characterizes two types of early-stage RPOH progression: Chondrolysis with or without subsequent femoral head destruction within 12 months of onset. Based on their association with early disease progression in RPOH, elevated serum matrix metalloproteinase-3 levels and spinopelvic malalignment may serve as predictive factors for subsequent bone destruction when only joint space narrowing is observed. This review also proposes potential mechanisms of pathogenesis and intervention strategies for RPOH at its initial stage. Cartilage matrix fragments generated by stress concentrations on the hip joint, resulting from spinopelvic malalignment, may trigger inflammatory pathways involving proinflammatory cytokines and inflammasome activation, ultimately leading to joint destruction in the initial phase of RPOH. Suppression of these early pathological events may prevent joint destruction caused by RPOH. However, further elucidation of the cellular and molecular pathways involved in rapid joint destruction is necessary to identify specific biomarkers for early diagnosis and to facilitate the development of targeted therapies in the initial phase of RPOH.

Keywords: Rapidly progressive osteoarthritis; Hip joint; Classification; Early diagnosis; Early intervention; Imaging; Matrix metalloproteinase-3; Spinopelvic alignment; Pathophysiology

Core Tip: Disease progression of rapidly progressive hip osteoarthritis in the early stages may be classified into two distinct types: Chondrolysis with or without subsequent femoral head destruction. Serum matrix metalloproteinase-3 levels and spinopelvic malalignment may be predictive factors for subsequent bone destruction when only joint space narrowing is observed. Cartilage matrix fragments generated by stress concentrations on the hip joint due to spinopelvic malalignment may trigger inflammatory pathways involving cytokine and inflammasome activation, resulting in joint destruction during the initial phase of rapidly progressive hip osteoarthritis. A clear understanding of its pathogenesis is essential for early diagnosis and effective intervention.