1412 - Low-Dose Radiation Therapy for Refractory Hip Osteoarthritis in a Patient with Ehlers-Danlos Syndrome and Mast Cell Activation: A Case Report

A 58-year-old female with a history of Ehlers-Danlos syndrome and mast cell activation syndrome presented with progressive right hip pain causing significant functional limitations. Radiographs showed moderate hip osteoarthritis. MRI demonstrated full-thickness cartilage loss in the anterior-superior hip and moderate effusion and synovitis. She underwent an ultrasound-guided corticosteroid injection in 2020 with good short-term relief but experienced prolonged insomnia and declined repeat injection. Surgical consultation determined that hip replacement was contraindicated due to her mast cell activation syndrome. By 2023, her pain worsened, with episodes of hip locking and impaired mobility. 

In April 2024, she was referred for LDRT and underwent 0.5 Gy × 6 fractions delivered twice weekly to the right hip. She experienced improvement in pain and function after the first fraction. At one-year follow-up, she reported sustained pain relief, unrestricted activity, and a 13-kg weight loss due to increased mobility. No adverse effects of radiation were observed. 




Discussions: Osteoarthritis remains a leading cause of disability, and management is particularly difficult in patients with contraindications to surgery or intolerance to pharmacologic therapies1. LDRT has been utilized internationally for degenerative joint disease but is rarely applied in the United States. This case demonstrates that LDRT may provide rapid, durable improvement in pain and function without adverse effects, even in medically complex patients. LDRT has been shown to have anti-inflammatory, immunomodulatory, and chondroprotective effects that can help reduce pain and slow OA progression2. While the exact cellular pathways are still being studied, LDRT is a promising adjunctive therapy in OA management. 

Conclusions: LDRT may be a safe and effective option for refractory hip osteoarthritis in patients who are not surgical candidates. Further investigation is warranted to establish protocols, patient selection criteria, and broader adoption in the United States.