Total hip arthroplasty in patients with Paget’s disease of bone: A systematic review

Abstract

AIMTo investigate the clinical and functional outcomes following total hip arthroplasty (THA) in patients with Paget’s disease.METHODSWe carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of THA in patients with Paget’s disease. Eight studies involving 358 hips were reviewed. The mean age was 70.4 years and follow-up was 8.3 years. There were 247 cemented THAs (69%), 105 uncemented THAs (29%) and 6 hybrid THAs (2%).RESULTSAll studies reported significant improvement in hip function following THA. There were 19 cases of aseptic loosening (5%) at a mean of 8.6 years. Three cases occurred in the uncemented cohort (3%) at a mean of 15.3 years and 16 cases developed in the cemented group (6%) at a mean of 7.5 years (P = 0.2052). There were 27 revisions in the 358 cases (8%) occurring at a mean of 7 years. Six revisions occurred in the uncemented cohort (6%) at a mean of 8.6 years and 21 in the cemented cohort (9%) at a mean of 6.5 years (P = 0.5117).CONCLUSIONThe findings support the use of THA in patients with Paget’s disease hip arthropathy. The post-operative functional outcome is largely similar to other patients; however, the revision rate is higher with aseptic loosening being the most common reason for revision. Uncemented implants appear to be associated with a lower failure rate, however, there were no modern stem designs fixed using current generation cementing techniques used in the reported studies, and as such, caution is advised when drawing any conclusions.

Benign Tumor-Like Conditions of the Hip

“…11,12 In the United States, 3 to 4% of the population over the age of 55 years is afflicted, with roughly 20 to 80% of these cases involving the pelvis or proximal femur. 13 Radiographic imaging may reveal lytic, blastic, or mixed phase lesions disease (►Fig. 2).…”

“…11 Specifically, for the hip joint, coxa vara, medial joint space narrowing, and acetabular protrusion can also be seen on radiographs. 11,13 A radioisotope bone scan is recommended at the time of diagnosis to assess for other areas of bony involvement, although the use of bone scans to evaluate the response to treatment is not recommended. 12 Unless assessing for the malignant transformation to osteosarcoma, a diagnostic biopsy is not recommended as the procedure may cause increased weakness in an already compromised area, leading to a fracture.…”

“…Surgical options such as corrective osteotomy or hip arthroplasty carry an increased risk of bleeding due in part to the hypervascularity of these lesions. 11,13 For lesions involving the periarticular region, a total hip arthroplasty is indicated. While cemented hip arthroplasty techniques carry a risk of decreased adherence of the bone-cement interface, uncemented techniques may result in decreased adherence of the implant-bone junction, with the latter being caused by weak pagetoid bone.…”

“…While cemented hip arthroplasty techniques carry a risk of decreased adherence of the bone-cement interface, uncemented techniques may result in decreased adherence of the implant-bone junction, with the latter being caused by weak pagetoid bone. 11,13 Increased rates of revision total hip arthroplasty in those with Paget's disease have been reported. 13 The complications inherent in this patient population are outside the scope of this article.…”

Diagnostic Aspects of Paget’s Disease of Bone in Clinical Practice

“…Пред-почтение в терапии заболевания отдается бисфосфонатам в силу их избирательного действия на костную ткань и длительного сохранения стойкого эффекта [28][29][30][31][32]. Таким образом, двукрат-ное введение золедроновой кис-лоты пациентке с КБП позво-лило достичь низкого уровня активности заболевания, что согласуется с данными других авторов [33][34][35][36], и провести артропластику тазобедренного сустава. Врачам, работающим с костной патологией, надо знать об этом заболевании вви-ду его высокой распространен-ности, поскольку своевремен-ная терапия позволяет избежать прогрессирования болезни, раз-вития ее осложнений и потреб-ности в высокотехнологичной медицинской помощи.…”