Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget’s disease: a combined registry and single-institution retrospective observational study

Abstract

Background Total hip arthroplasty (THA) in patients with Paget’s disease can be associated with technical difficulties related to deformities and altered mechanical bone properties, and hypervascularity leads to significative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications. Material and methods Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed. Results In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved significantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifications. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1–6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second post-operative day. Conclusion THA surgery in Paget’s patients is a safe procedure, and implant survival is only partly affected by bone remodelling and choice of fixation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development. Level of evidence Level III

Global mapping of institutional and hospital-based (Level II–IV) arthroplasty registries: a scoping review

“…ORTHOTEP University HS Carl Gustav Carus [ 109 , 619 ] 2. Dresden Hip Surgery Registry [ 52 , 196 ] Heidelberg University of Heidelberg [ 410 ] Regensburg Regensburg University [ 198 , 255 , 292 , 296 , 299 ] Greece Athens General HS KAT [ 155 , 384 , 646 ] Thessaloniki Arthroplasty RG Thessaloniki (ART) [ 2 , 12 , 406 , 455 , 647 ] Italy Emilia-Romanga Register of Orthopaedic Prosthetic Implant (RIPO) [ 24 , 26 , 39 , 43 , 57 , 145 , 164 , 189 , 231 , 288 , 297 , 468 , 476 , 482 , 491 , 502 , 506 , 508 , 527 , 540 , 562 , 563 , 569 , 585 , 592 , 597 , …”

“…The “Register of Orthopaedic Prosthetic Implant (RIPO) of Emilia-Romagna region” published 30 papers from 2002 to 2022 [ 24 , 645 ]. Among them, twenty-eight were cohort studies [ 24 , 26 , 39 , 43 , 57 , 145 , 164 , 189 , 231 , 288 , 297 , 482 , 491 , 502 , 506 , 508 , 527 , 540 , 562 , 563 , 569 , 585 , 592 , 597 , 599 , 624 , 630 , 645 ], one was RCT [ 476 ] and one registry protocol [ 468 ]. Of these 30 studies, 16 were survival [ 26 , 164 , 189 , 231 , 288 , 482 , 491 , 502 , 508 , 527 , 540 , 563 , 569 , 585 , 592 , 599 ], six analysed implant types [ 24 , 43 , 297 , 506 , 624 , 645 ], and two studied postoperative complications [ 597 , 630 ].…”

“…Among them, twenty-eight were cohort studies [ 24 , 26 , 39 , 43 , 57 , 145 , 164 , 189 , 231 , 288 , 297 , 482 , 491 , 502 , 506 , 508 , 527 , 540 , 562 , 563 , 569 , 585 , 592 , 597 , 599 , 624 , 630 , 645 ], one was RCT [ 476 ] and one registry protocol [ 468 ]. Of these 30 studies, 16 were survival [ 26 , 164 , 189 , 231 , 288 , 482 , 491 , 502 , 508 , 527 , 540 , 563 , 569 , 585 , 592 , 599 ], six analysed implant types [ 24 , 43 , 297 , 506 , 624 , 645 ], and two studied postoperative complications [ 597 , 630 ]. Long-term postoperative outcomes [ 562 ], cost [ 57 ] and risk factors analysis [ 39 ], genetic studies [ 476 ], a protocol for registry study [ 468 ] and comparison of different surgical techniques [ 145 ] were among the primary outcomes of other study types.…”

Almost 79% survival rate at 10‐year follow‐up for the patellofemoral joint arthroplasty: An Italian prosthetic registry study

“…Any surgical procedure performed anywhere in Italy is reported and billed to the patient's region of residence. The primary endpoint of the registry is the revision of one or more prosthetic implant components [8].…”

Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique

“…Those patients present less bone stock compared to others affected by Crowe IV deformity, where the total dislocation of the hip preserves the true acetabulum. Hip replacement in Crowe III patients can be performed in two ways, namely, using a high hip center technique, or by restoring the anatomic center of rotation (COR) at the true acetabulum [4][5][6]. The high hip center technique maintains COR in the false acetabulum; it is associated to some advantages because it reduces the risk of neurologic complications and avoids the performance of a shortening femoral osteotomy, reducing associated risks of intraoperative complications and operative time [7][8][9].…”