Total hip replacement for Pagetʼs disease of the hip.

Merkow, Robert L.; Pellicci, Paul M.; Hely, D P; Ea, Salvati

doi:10.2106/00004623-198466050-00015

Cited by 69 publications

(34 citation statements)

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“…At latest follow-up, good and excellent results were decreased [21]. Radiolucent lines have been reported in up to 40% of cemented cups implanted into pagetic bone in other series [24]. Inability to achieve a dry bed for cementation may compromise long-term fixation [15].…”

Section: Discussionmentioning

confidence: 98%

“…Cemented THAs have been reported with short-to mid-term satisfactory outcomes among pagetic patients [16,21,23,24,31,32]. Nevertheless, concerns regarding an increased incidence of radiolucent lines around pagetic bone-cement interface and the potential for loosening have been raised at long-term follow-up [12,21,23,24,33].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, concerns regarding an increased incidence of radiolucent lines around pagetic bone-cement interface and the potential for loosening have been raised at long-term follow-up [12,21,23,24,33]. Failure rates leading to revision as high as 15% have been reported with cemented components implanted into pagetic bone [21].…”

Section: Discussionmentioning

confidence: 99%

“…The average age at surgery was 74.2 years (range 55-89) and the average time to diagnosis of PDB was 13.1 years (range 1-36). The average body mass index was 25 kg/m² (range [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. The 39 procedures included 37 primary replacements and two revision procedures.…”

Section: Methodsmentioning

confidence: 99%

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Cementless total hip arthroplasty in Paget’s disease of bone: a retrospective review

Wegrzyn¹,

Pibarot²,

Chapurlat³

et al. 2009

International Orthopaedics (SICOT)

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Paget's disease of bone (PDB) is a localised chronic osteopathy leading to bone deformities, bone hypervascularity, structural weakness and altered joint biomechanics. The pelvis and upper femur are frequently involved, resulting in disabling hip disease, and total hip arthroplasty (THA) may be required. We performed a retrospective study on the management and the outcome of 39 uncemented hydroxyapatite fully-coated THA in patients with PDB of the hip. The follow-up averaged 79.4 months (range 24-194). Functional scores improved significantly and, using the Harris hip score, 84% of patients had an excellent clinical outcome at the latest follow-up. Despite one case of an uncemented acetabular component with probable loosening, no implant revision had been required at our latest follow-up. Signs of implant loosening were found to be significantly more frequent in patients with active disease. For this reason, we advocate the use of pre-operative medication with bisphosphonates to reduce disease activity. Another benefit of this treatment is the significant decrease of intra-operative blood loss. Provided the control of disease activity in the pre-operative period with bisphosphonates is achieved, good outcome of cementless THAs can be expected. Bisphosphonates reduced the risk of implant loosening and excessive intra-operative blood loss

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Cementless total hip arthroplasty in Paget’s disease of bone: a retrospective review

Wegrzyn¹,

Pibarot²,

Chapurlat³

et al. 2009

International Orthopaedics (SICOT)

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“…Limb salvage surgery on pagetic bone poses certain problems [26,27]. The aggressive sarcomatous tissue in an already vascularised pagetic bone requires utmost caution during the perioperative period [28].…”

Section: Discussionmentioning

confidence: 99%

Osteoblastic osteosarcoma in monostotic Paget’s disease

2011

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Paget's disease is a disorder of bone remodelling affecting 1-2% of the general population, most frequently men over 50 years of age. Sarcomatous degeneration occurs in 0.1-0.95% of patients with Paget's disease. It can be observed in monostotic and polyostotic disease. Osteosarcomas account for more than 80% of pagetic sarcomas; osteoblastic pagetic osteosarcomas are rare. In this article, we present the case of a 75-year-old man with secondary osteosarcoma arising in monostotic Paget's disease, initially misdiagnosed as rotator cuff tendinopathy. Imaging studies and biopsy were diagnostic.

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Surgical management of paget's disease

Kaplan

1999

Journal of Bone and Mineral Research

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Orthopedic complications of Paget's disease wcur commonly and arise as a result of chronically accelerated bone remodeling in focal regions of the skeleton. Complications include pathologic fractures with delayed union, progressive skeletal deformity, chronic bone pain and pagetic arthritis. The new bisphosphonates have transformed the treatment of Paget's disease in the past decade but have not yet been studied in depth for their ability to prevent orthopaedic complications. Although few patients with Paget's disease ever require surgical intervention, successful operative management of orthopaedic complications has dramatically improved the quality of life for many sufferers. Selected modalities with promising results include total hip replacement for end-stage pagetic arthritis of the hip, total knee replacement for end-stage pagetic arthritis of the knee, proximal tibial osteotomy for painful malalignment of the knees, internal fixation for pathological fractures, and decompressive laminectomy for spinal stenosis. Complications of surgery on pagetic bone include hemorrhage, infection, pathologic fracture, delayed union, nonunion, and aseptic loowning of hardware. Medical, surgical, and rehabilitative modalities provide a wide array of options in managing orthopaedic complications of Paget's disease and are useful in improving quality of life for sufferers of the condition. Prospective studies are needed to assess the ability of antipagetic medications to prevent severe long-term complications such as deformity, arthritis, and malignancy. Localization of susceptibility genes for Paget's disease may accelerate identification of targets for gene therapy and disease prevention. (J Bone Miner Res 1999;14, suppl. 2:%38)

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Total hip replacement for Pagetʼs disease of the hip.

Cited by 69 publications

References 0 publications

Cementless total hip arthroplasty in Paget’s disease of bone: a retrospective review

Cementless total hip arthroplasty in Paget’s disease of bone: a retrospective review

Osteoblastic osteosarcoma in monostotic Paget’s disease

Surgical management of paget's disease

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