Destructive arthropathy of the hip following pelvic irradiation: report of four cases.

The replacement of orthovoltage by megavoltage radiotherapy has facilitated selective ablation of cancerous tissue, resulting in less toxicity to bone. However, damage to bone still occurs and may be more common than generally appreciated. In four women, all treated for adenocarcinoma of the reproductive tract, radiotherapy was believed to contribute to acetabular failure and secondary arthritis 2 to 31 years after treatment. In one case the condition was bilateral. Because arthritis of the hip is now common in women, there is a risk that unusual and remote factors may not be recognized or fully appreciated. In these cases prosthetic joint replacement is likely to fail. Special techniques, including bone grafting, peripheral support rings, well-fixed and optimally placed sockets and gradual rehabilitation, are mandatory.