Rapidly destructive osteoarthritis or rapidly destructive arthrosis (RDA) of the hip is an uncommon disorder of unknown etiology where there is a rapid destruction of both the acetabulum and the femoral head. The condition typically affects elderly females with normal or osteoarthritic hip joints, and presents with new-onset severe hip pain and dysfunction. It is thought to be caused by extremely rapid osteoarthritic changes leading to an impact of the femoral head into the acetabulum, with subsequent osteonecrosis and insufficiency fracture of the femoral head. Differential diagnosis should include those conditions known to potentially lead to rapid hip destruction, such as septic arthritis, metabolic bone diseases, autoimmune inflammatory arthritis, malignancy and classical osteonecrosis. Sequential X-rays in patients with fast worsening of hip symptoms and a high degree of clinical suspicion seem mandatory to avoid extensive joint destruction and facilitate better arthroplasty outcomes in these patients. In the present report we present a clinical case of bilateral RDA, and we offer a useful review for clinicians on the differential diagnosis of this condition and the main physiopathological mechanisms behind its occurrence.