Usefulness of the Kinect-V2 System for Determining the Global Gait Index to Assess Functional Recovery after Total Knee Arthroplasty.

OBJECTIVE: The Korean Knee Society (KKS) score is used for functional evaluation during follow-up after total knee arthroplasty (TKA), but it is time-consuming to measure and is limited by its subjective nature. We investigated whether the global gait asymmetry index (GGA) that can be obtained using the Kinect-V2 system could overcome the KKS limitations. METHODS: Forty-three patients who underwent TKA from January 2019 to December 2019 were included. Postoperatively, regular follow-up was performed at 2, 4, 6, 8, and 12 weeks, and at 4, 6, and 12 months. At each follow-up visit, the KKS was measured, and the walking path was followed with six Kinect-V2 systems. After allowing the participants to walk naturally, the range of motion of each joint of the lower extremity and GGA were obtained. Changes in the KKS and GGA scores and measurement times were investigated until the final follow-up. A statistical model was made to predict the KKS from the GGA score using data at all observed time points, and analysis of variance (ANOVA) with Turkey's post-hoc tests and Pearson correlation tests were used for evaluation. RESULTS: Both the KKS and GGA scores improved significantly from 4 weeks postoperatively until the final follow-up. The measurement time was significantly shorter for the GGA (9.3 ± 1.4 min) than for the KKS (32.4 ± 9.2 min; P < 0.001) score. The predicted and actual KKS values clustered close to a straight line on the scatter plot, but the prediction was less accurate in the initial stage (2 weeks post-surgery) than at later time points. The mean absolute error (MAE) and root mean square of the error (RMSE) were considered to be poorly predicted in the initial stage (8 weeks post-surgery) compared to the later time-points (MAE ≥ 5 and RMSE ≥ 6 for 8 weeks post-surgery). CONCLUSION: In the early phase after knee joint surgery (up to 12 weeks post-surgery), the GGA index does not predict the KKS well. However, after this time point, the GGA index can be simply measured in the outpatient department and may be able to replace the KKS. Thus, evaluation of the GGA index using the Kinect-V2 may be a useful method to evaluate functional recovery in the outpatient clinic after knee joint surgery.

A finite element analysis and cyclic load experiment on an additional transcortical-type hole formed around the proximal femoral nail system's distal locking screw.

BACKGROUND: A complication associated with the distal locking screw used in the proximal femoral nail (PFN) system is the formation of accidental additional holes. We hypothesized that an increase in stress around additional holes is a relevant factor contributing to fractures. This study aimed to evaluate stress changes in the cortical bone around additional screw holes using finite element analysis. METHODS: Proximal femoral nail antirotation (PFNA)-II (Synthes, Solothurn, Switzerland) was inserted into a femur model. An additional 4.9-mm transcortical hole was made either anteriorly (anterior hole model) or posteriorly (posterior hole model) to the distal locking screw. Finite element analysis was used to calculate compression, tension, and load limits to investigate stress around additional holes with respect to the direction of screw penetration and degree of osteoporosis. The results were then compared with those of mechanical testing. A 31A-21 type intertrochanteric fracture was applied. As a control group, a model without additional holes (no-hole model) was developed. Repeated load-loading tests were performed on 10 model bones per model group. RESULTS: Tensile stress was significantly greater in the no-hole model when additional screw holes were present, and the anterior hole showed a higher maximum stress value than the posterior hole, suggesting that the anterior hole was more susceptible to fracture. The change in tensile stress first appeared in the hole around the lateral cortical bone and proceeded to the medial side. Biomechanical testing showed that fractures around the distal locking screw occurred in 0 cases of the no-hole, 10 of the anterior hole, and 9 of the posterior hole models. CONCLUSIONS: During PFN surgery for intertrochanteric fracture, holes with distal locking screws fixed and removed at the anterior and posterior of the nail can be a risk factor for fractures in the surrounding area.

Screw penetration of the iliopsoas muscle causing late-onset pain after total hip arthroplasty: A case report.

BACKGROUND: Postoperative pain following total hip arthroplasty (THA) may occur in a few patients but may pose a significant challenge to surgeons if the etiology is not identified. Herein, we report the case of a patient who developed late-onset pain following THA due to screw penetration of the iliopsoas tendon. CASE SUMMARY: We report the case of a 77-year-old man who developed inguinal pain 7 years after THA. While the symptoms resembled that of iliopsoas impingement by the acetabular cup, the pain resolved only when the supplementary acetabular screw protruding through the ilium was decompressed. Decompression was performed using the pararectus approach. The patient was able to ambulate pain-free immediately after surgery. CONCLUSION: A protruded screw through the ilium may penetrate the iliopsoas muscle, causing pain following THA. Pain may resolve with the decompression of the protruded screw.

Conventional versus helical blade screw insertion following the removal of the femoral head screw: a biomechanical evaluation using trochanteric gamma 3 locking nail versus PFN antirotation.

OBJECTIVE: When a hip screw needs to be changed, choosing between the conventional (C-type) and helical blade (H-type) types is difficult. In this biomechanical study, we compared these two screw types relative to the type of the initial screw used. METHODS: C- or H-type screws were inserted (leading screw) in three types of polyurethane bone models (Sawbone, Pacific Research Laboratories, Inc., Washington, USA: 130 × 180 × 40 mm) of different bone mineral densities (pounds per cubic feet [PCF] 5, 80 kg/m3; PCF 10, 160 kg/m3; and PCF 15, 240 kg/m3), and then successively or alternately inserted (following screw) after the leading screw removal. An original model (original C and H) of a leading screw without removal was created as a control. The strengths of resistance to pullout (PO) and rotational stress were measured. For each experimental condition, there were 30 experimental models. RESULTS: The original C screw was superior in PO strength, and the original H-type screw was superior in rotational strength. When the C- or H-type screw was the leading screw, using the C-type screw again as the following screw (C1-C2, H1-C2) showed the greatest resistance to PO, and using the H-type screw as the following screw (C1-H2, H1-H2) showed superior resistance to rotational strength. However, the rotational strength of the C2 screw decreased by more than 50% compared with that of the original C screw. Moreover, the PO and rotational strengths of the H2 screw decreased to less than 30% overall compared with those of the original H screw. CONCLUSION: The H-type screw should be used for second-time screw insertion procedures in cases where it is difficult to choose between PO and rotational strengths.

Is it advantageous to use the intraoperative compression option of proximal femoral nail antirotation in the treatment of osteoporotic intertrochanteric fractures? A retrospective comparative study.

OBJECTIVE: The aim of this study was to retrospectively compare the radiological and clinical results of intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA) that were either intraoperatively compressed or non-compressed. METHODS: Ninety-four patients (64 female, 30 male; mean age = 77.6 years; age range = 68-81) who underwent intraoperative fracture compression (IOFC) (94 hip joints, group A) and 88 patients (64 female, 24 male; mean age = 77.1 years; age range = 67- 80) who underwent postoperative impaction (POI) alone (88 hip joints, group B) from2012 to 2017 met the following six conditions were observed for over 2 years: AO Foundation/Orthopaedic Trauma Association 31-A1 and 31-A2 trochanteric fractures; Singh index grade ≥ 3; positive or neutral medial cortical support position with slightly valgus reduction; possible compression of more than one cortical bone in the anterior or medial region of the fracture site based on preoperative imaging test; blade position within the center-center; andtip-apex distance of < 25 mm. During the follow- up periods, changes of pain and time to fracture union were evaluated clinically, and the lateral extension distance (for screw back-up) was evaluated radiologically which measuredbetween the lateral end of the screw and lateral edge of the intramedullary nail. RESULTS: The mean follow-up was 38.4 (range = 24-48) months in Group A and 36.7 (24-48) months in Group B. The mean operation time was 68 (range = 40-100) min in group A and 71 (range = 40-105) min in Group B (P = 0.521). Intraoperative blood loss was 78 (range = 50-110) mL in Group A and 81 (range = 50-100) mL in Group B (p=0.715). The mean fluoroscopy time was 2.8 (range = 2.2-3.5) min in Group A and 2.6 (range = 2.1-3.5) min in Group B (P = 0.631). The acute phase pain scores measured by visual analog scale at postoperative 3 months were 35.5 in Group A and 37.6 in Group B (P = 0.073). The lateral extension of the PFNA blade showed significant difference at 24 months after surgery (Group A, 3.6±3.1 mm; group B, 7.8±3.7 mm, P = 0.017). Fracture gaps after surgery were 1.8 (range = 0.5-2.5)mmin Group A and 2.6 (range = 0.7-4.6)mmin Group B, showing significant difference (P = 0.001). The average fracture union time was 16.7 (range = 14-20) weeks in Group A) and 19.7 (range = 16-22) weeks in Group B (P = 0.065). The mean Harris Hip Scores at postoperative 24 months were 84.3 (range = 65-100) in Group A and 85.5 (range= 69-100) in Group B (P = 0.545).p Conclusion: If all the six conditions are met, IOFC seems to appropriate for AO/OTA 31-A1 and 31-A2 intertrochanteric fractures with the smaller postoperative fracture gap and lateral protrusion of the blade, which may contribute to the shortening of fracture union periods. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Conservative treatment using a sponge cast for transfer fractures in nursing home patients.

BACKGROUND: Transfer fractures in the lower limbs of bedridden and chair-bound nursing home patients can result from trauma induced by the usual lifting, moving, turning, or transferring maneuvers. Treatment entails immobilization for pain control and position change; however, splints/hard casts increase the risk of pressure sores. Therefore, we evaluated the use of a sponge cast. MATERIALS AND METHODS: Between March 2011 and October 2017, 17 patients with a lower limb transfer fracture due to transferring maneuvers in a nursing home were recruited. We evaluated the improvement in pseudo-motion and divided the patients as having bony union, fibrous union, or remaining pseudo-motion. We also investigated the occurrence of pressure sores due to immobilization up until the final follow-up. RESULTS: Femur fractures occurred in 15 patients and lower leg fractures in two. Six of the 15 femur fractures were periprosthetic (four hip arthroplasty and two knee arthroplasty). Pseudo-motion was improved in 15 of 17 cases, within an average of 17.3 weeks for the improvement (14-23 weeks; bony union: 11 cases and fibrous union: four cases). Pseudo-motion remained in two cases: one periprosthetic fracture around the knee arthroplasty and the other, a femur neck fracture. No pressure sores occurred. CONCLUSIONS: A sponge cast appears to be one of the effective treatment options available for bedridden or chair-bound patients with a lower limb fracture due to its low risk of complications and satisfactory clinical results.

Bilateral Avascular Necrosis of the Femoral Head in a Patient with Asymptomatic Adrenal Incidentaloma.

Except when caused by direct and definite mechanisms (e.g., injury of the vessels to the femoral head), the pathophysiology of avascular necrosis of the femoral head has not yet been fully elucidate. While non-traumatic avascular necrosis of the femoral head is known to be caused by alcohol, steroids and various diseases, it may also occur without such events in a patient's history. Herein, a case of bilateral avascular necrosis of the femoral head caused by asymptomatic adrenal cortex incidentaloma which was initially misdiagnosed as idiopathic is reported along with a literature review.

Effect of surgical approach for contralateral side hip arthroplasty in below knee amputees: a retrospective cohort study.

BACKGROUND: The gluteus medius muscle plays a very important role in the stability of the gait, especially in patients with amputation of the lower limbs. Therefore, choosing the appropriate type of approach for hip arthroplasty is very important. Hence, this study aimed to compare the outcomes and complications between the anterolateral approach (ALA) and posterior approach (PA) for hip arthroplasty in patients with contralateral below knee amputation. METHODS: From January 1999 to November 2014, 67 patients who underwent hip arthroplasty with contralateral below knee amputation were retrospectively analyzed. The study subjects were divided into two groups: the PA group (33 cases) and the ALA group (34 cases). The results of the clinical functional recovery with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Harris Hip Score, and activity of daily living scale were compared between the two groups. During the follow-up period, complications related to gait such as fall, dislocation, and periprosthetic fractures (PPFs) were investigated. RESULTS: The Harris Hip Score (p = 0.024) and the activity of the daily living scale (p = 0.043) of the ALA group were significantly lower at 3 months compared to the PA group, but no significant difference was observed between the two groups from 6 months postoperatively to the last follow-up. The WOMAC score was not significantly different between the two groups. Within 3 months after surgery, falls occurred in 3 cases in the PA group and in 11 cases in the ALA group (p = 0.019) Dislocation and PPF were caused by prosthesis-related trauma. Two dislocations and 1 PPF occurred 8 years postoperatively in the PA group. PPF occurred in 3 patients in the ALA group, of which 2 occurred within 3 months after surgery. CONCLUSION: Orthopedic surgeons should pay particular attention in patients with hip arthroplasty on the contralateral side hip who had below knee amputation because functional recovery is delayed until 3 months after ALA compared with PA.

Mid-to long-term results of total hip arthroplasty after contralateral lower extremity amputation.

OBJECTIVE: There is limited literature concerning the outcomes and role of THA as a surgical option for amputee patients. The aim of this study is to determine the mid-to long-term survival and complication rates of cementless total hip arthroplasty (THA) in patients with contralateral below knee amputations. METHODS: A retrospective review of 54 patients with below knee amputation were perfomed who underwent THA for osteoarthritis of the contralateral hip over a 5-year period between 1999 and 2014. Patients were monitored for at least 5 years and assessed with the Harris Hip Score and activities of daily living scale and by evaluating migration or osteolysis around the acetabular cup and femoral stems (amputee group). The amputee group was compared with a control group (non-amputee group) with the same number of patients. RESULTS: Differences in the Harris Hip Score (p = 0.021) and activities of daily living scale (p = 0.043) between the two groups were statistically significant lower in the amputee group at 3 months after surgery. However, no differences were found between the groups from 6 months postoperatively to the last follow-up (Harris Hip Score p = 0.812, activities of daily living scale p = 0.885). Radiologically, any cups or stems showed no signs of migration or osteolysis. In the amputee group, dislocation was found in 1 patient 2 months after arthroplasty (p = 0.315) and long stem revision surgery were performed on two patients due to periprosthetic fracture (p = 0.153). CONCLUSIONS: THA performed on the contralateral side of patients with below knee amputation is considered to be an effective treatment with good clinical and radiological results at mid-to long-term follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic study.

One-year Survival Rates and Functional Recovery in Veterans Who Suffer from Hip Fractures: Evaluation of Commissioned Hospitals' System through Comparison between Veterans Hospitals and Commissioned Hospitals.

PURPOSE: This study was performed to compare the: i) 1-year survival rate of patients with hip fractures, ii) factors affecting mortality in patients with hip fractures, and iii) results of functional recovery at commissioned hospitals (CH) and veterans hospitals (VH) to characterize the quality of care provided in the Korean commissioned hospital system. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 and 99 treated at a single VH and 39 CH, respectively) who underwent hip fracture surgery between January 2010 and February 2015. This study compared baseline characteristics (i.e., age, comorbidities, fracture types and surgical treatment approaches) of the two groups vs. clinical outcomes, and evaluated the waiting time, length of hospital stay, total medical expenses, mortality rate within one year, and functional recovery at last follow up. RESULTS: There were no significant differences in age, fracture types, comorbidities, ambulatory status before fracture, waiting time, or length of hospital stay between the two groups, however, the total medical cost was higher in the CH group (P=0.009). There was no significant difference in mortality within one year after hip fracture (P=0.224) or functional recovery at last follow-up (P=0.463) between the two groups. CONCLUSION: The results of this study confirm that the Korean commissioned hospitals system is operating in accordance with its purpose. However, further studies are needed to better characterize the medical expenses of CHs vs. veterans hospitals.

Acute Arterial Occlusion Following Primary Total Knee Arthroplasty.

Acute arterial occlusion is a rare complication following total knee arthroplasty (TKA). This is a report of a case of acute femoral artery occlusion and its sequelae following TKA in a patient with a history of atrial fibrillation. Arterial circulation of the lower limb could not be restored by thrombectomy treatments, and above-knee amputation had to be carried out.

What Is Important in Selecting a Designated Hospital for the Korean Veterans with Hip Fractures?

PURPOSE: The Korea Veterans Health Service (KVHS) implemented the 'designated hospital system' so that veterans can receive prompt medical attention at hospitals near their residences when experience medical emergencies, including hip fractures. We analyzed the hospital-selection process of Korean veterans following a hip fracture. We then evaluated (the validity and considerations) for choosing designated hospitals. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 treated at a single veterans hospital and the remaining 99 treated at 39 designated hospitals) who underwent hip fracture between January 2010 and February 2015 in the Honam region of South Korea. The subjects were divided into the 'nearest group' (those who chose the hospital closest to their residences) and the 'non-nearest group' (those who did not choose the hospital closest to their residences). We compared the age, ambulatory status, combined disease and fracture type, factors that we speculated may impact hospital choice. RESULTS: Although the patients had difficulty moving due to hip fractures, 116 (63.4%) patients choose hospitals that were not closest to their residences. Patients with three or more comorbidities (P=0.028) and older ages (P=0.046) were statistically more likely to fall into the non-nearest group. Ambulatory status and fracture type were shown not to significantly impact choice between nearest and non-nearest hospital. Patients in the non-nearest group tended to seek care at larger hospitals. CONCLUSION: Korean veterans with hip fractures tended to seek care at larger hospitals, regardless of distance. We must therefore consider the number of beds and departments when choosing designated hospitals.

Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines.

Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty.

Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents.

Following the implementation of a long-term care insurance system for the elderly in Korea, many nursing homes have been established and many more patients than ever before have been living at nursing homes. Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes. We recently studied 46 cases of hip fracture in nursing homes; more specifically, we investigated the most common conditions under which fractures occur, and examined the degree of recovery of ambulatory ability and the mortality within 1 yr. Among those who had survived after 1 yr, the number of non-functional ambulators increased from 8 hips before hip fracture to 19 hips at final post-fracture follow-up. These individuals showed poor recovery of ambulatory ability, and the number who died within one year was 11 (23.9%), a rate not significantly different from that among community-dwelling individuals. It was evident that hip-joint-fracture nursing home residents survived for similar periods of time as did those dwelling in the community, though under much more uncomfortable conditions. The main highlight of this report is that it is the first from Korea on nursing home residents' ambulatory recovery and one-year mortality after hip fracture. The authors believe that, beginning with the present study, the government should collect and evaluate the number of hips fractured at nursing facilities in order to formulate criteria that will help to enable all patients to select safer and better-quality nursing facilities for themselves or their family members.

Clinical and Functional Outcomes of Treatment for Type A1 Intertrochanteric Femoral Fracture in Elderly Patients: Comparison of Dynamic Hip Screw and Proximal Femoral Nail Antirotation.

PURPOSE: We aimed to evaluate and compare the clinical and functional outcomes of dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) treatment of AO type 1 intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: We retrospectively reviewed 194 consecutive patients with type A1 intertrochanteric femoral fractures who were treated with DHS (n=113) or PFNA (n=81). We evaluated operation time, intraoperative blood loss, and functional outcomes, walking ability, and the Barthel activities index. Fracture union, sliding of hip screw, proximal femur shortening, and presence of complications were assessed radiologically at relevant follow-up intervals. RESULTS: The mean operation time and blood loss were significantly lower for the PFNA group, but walking ability and Barthel index decreased to a similar extent for both groups. However, patients in the DHS group complained of significantly more pain (P=0.049). Although there were no significant differences between the two groups with respect to the time until fracture union was achieved, patients in the DHS group exhibited a higher extent of proximal femoral shortening and sliding of the hip screw. Differences about hip screw sliding and proximal femur shortening within each subgroup were not significant. CONCLUSION: Compared to DHS treatment, PFNA treatment of type A1 intertrochanteric fractures is associated with reduced blood loss, shorter operation time, and less severe pain after surgery. Additionally, sliding of the hip screw and proximal femur shortening are expected to occur more frequently after DHS.

A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients.

PURPOSE: To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. MATERIALS AND METHODS: From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). RESULTS: Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. CONCLUSION: In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.

Surgical Treatment of Undisplaced Femur Neck Fractures in Dementia Patients Using Proximal Femoral Nail Antirotation.

PURPOSE: People with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients. MATERIALS AND METHODS: We studied retrospectively 19 patients with undisplaced femur neck fracture. All patients were over 70 years of age, walked independently with a cane or crutches and suffered moderate-to-severe dementia. Patients were treated with PFNA and followed-up for more than 2 years. Revision, loss of fixation, complications, and walking ability outcomes were measured. RESULTS: In walking-ability evaluation, patients showed an average decrease of just 0.2 points at the final follow-up. Walking ability was evaluated from before injury to 4 weeks after surgery and decreased by less than 0.5 points. Radiological bone union was achieved in 17 cases; the average time to bone union was 4.14 months (range, 2.5-7 months). Complications included non-union in two cases and femoral head avascular necrosis in one case of non-union. CONCLUSION: We found that for patients with osteoporotic bone tissues in their femoral heads or patients (e.g., those suffering dementia) for whom cooperating with medical workers for postoperative walking control or rehabilitation exercises is difficult, implanting a mechanically stable spiral blade for fixation of femoral neck fractures could facilitate walking after surgery.

Internal fixation of femoral head fractures (Pipkin I) using hip arthroscopy.

A hip arthroscopy technique for the reduction and internal fixation of a displaced femoral head fracture is presented. Open treatment is often required for femoral head fractures. However, it is shown below how large fragments of a femoral head fracture-dislocation were reduced and internally fixated using hip arthroscopy. This was performed in the supine position using skeletal traction. The accessory distal anterior portal was used for internal fixation when a hip was positioned in abduction with external rotation. A satisfactory outcome was reported. Recovery was immediate and cosmetics were excellent. We conclude that hip arthroscopy is a valuable option for managing femoral head fracture-dislocations (Pipkin I).

Rapid Destruction of the Hip Joint Accompanied by an Enlarged Iliopsoas Bursa in a Healthy Man.

Association between enlarged iliopsoas bursa and hip lesions such as osteoarthritis of the hip or femoral head necrosis is infrequently seen. Enlarged iliopsoas bursa with a rapidly destructive arthropathy is claimed to be seen only in patients with rheumatoid arthritis. In this paper, we report a patient with a rapidly destructive arthropathy accompanied by an enlarged iliopsoas bursa that has been misdiagnosed as an infection.