Rapidly destructive coxarthrosis (RDC) usually affects unilateral side. However, RDC arises at bilateral side in 10% cases. We report a case of bilateral RDC, which occurred during half year simultaneously.

 The case is an 82-year-old male. His chief complaint was bilateral groin and thigh pain. He had a medical history of bilateral TKA and hyper C-reactive proteinemia unknown origin (under follow-up at neighboring hospital). He visited our hospital 7 months ago because of persistent left knee pain for 2 months. At initial visit, blood test showed abnormally high levels of D-dimer and C reactive protein (CRP). However, deep venous thrombosis (DVT), loosening of implants and infection of left knee was not detected through precise examination. Radiograph revealed slight narrow hip joint space without destructive change of acetabulum and femoral head. One month ago, he felt swelling and severe pain of right lower limb and walking difficulty gradually got worsen due to the progressive symptoms. On admission of our hospital, radiograph, CT and MRI showed destructive change of bilateral femoral head and acetabulum. After examination of blood, blood culture and synovial fluid culture, we diagnosed preoperatively his case as bilateral RDC and performed bilateral THA 2 weeks later. After surgery, we confirmed diagnosis of bilateral RDC based on clinical course, imaging findings and pathological findings. At the period of 7 months after surgery, he could walk by himself with cane. JOA hip score was 76 points on the right and 81 points on the left respectively. Radiolucent line surrounding implants or loosening finding was not detected on radiograph.

 We experienced a case of bilateral RDC with extremely high value of D-dimer and CRP requiring differential diagnosis from DVT, pyogenic arthritis, rheumatoid arthritis, malignant tumor.