2016 Volume 28 Issue 2 Pages 143-149
We encountered a case of rheumatoid arthritis with hip destruction due to a communication between the hip joint and trochanteric bursa, even if this case preserved low disease activity. A 43-year-old woman with rheumatoid arthritis had a mass in the right buttock. Although she had no pain initially, she noticed a gradually growing mass, and developed pain and instability while walking within 3 years. Magnetic resonance imaging showed trochanteric bursitis in the buttock. The bursitis persisted despite aspiration for a few times, and hip destruction was subsequently detected. After total hip arthroplasty, she felt no pain in the right hip while walking.
Intraoperative findings of excessive synovial fluid that was discharged immediately after incision of the hip joint capsule demonstrated a communication between the trochanteric bursa and hip joint. Although some reports have described iliopectineal bursitis associated with rapid hip joint destruction, to our knowledge, no report has described a similar association between trochanteric bursitis and hip joint destruction. We speculated that the communication caused giant trochanteric bursitis, and it remained a few years because of a “valve-like mechanism” similar to that in a popliteal cyst.
