TOTAL HIP ARTHROPLASTY AND PAGET’S BONE DISEASE

Abstract

Purpose: Hip joint involvement is a frequent complication of Paget’s disease. We conducted a multicentric retrospective study to analyse perioperative problems and outcome after total hip arthroplasty in patients with Paget’s disease.

Material and methods: Thirty-nine total hip arthroplasties were implanted between 1979 and 1998 in 35 patients with Paget’s disease of the hip (four bilateral cases). The series included 20 men and 15 women, mean age 74 years (55–86). The pre and postoperative status was evaluated with the Harris score and radiographically. We recorded operative time, blood loss, and events noted in the operative report. Among the 35 patients, 24 were retained for analysis (three deaths, eight lost to follow-up) at mean 62 months.

Results: The mean preoperative Harris score was 46/100 (18–67). Eighteen patients had leg length discrepancy. Nine had permanent hip flexion associated with external rotation and seven had coxa vara. Twenty-nine patients were given anti-osteoclastic treatment preoperatively. We implanted 20 cemented cups and 19 press-fit cups. Thirty-one femoral stems were cemented and eight were not. On average, operative time was 130 minutes and blood loss was 830 cc. Difficult operative events involved luxation of the femoral head, remodelled sclerous bone (greater trochanter fractures, difficult reaming, narrow canal), cam effect related to bone hypertrophy and bleeding. Venous thrombosis occurred in four patients, pulmonary embolism in one, and one psoas haematoma. There were three luxations. At last follow-up (mean 71 months), the clinical outcome was excellent for 13 patients (48%), good for eight (29%), fair for two (7%) and poor for four (15%). Implants were cemented at the pelvis and femur level in three cases and noncemented in one.

Discussion: Prosthetic hip surgery in patients with Paget’s disease is difficult and raises the risk of postoperative complications. Prior medical treatment is needed before surgery to limit the risk of bleeding. In our series, fixation modalities were very variable. Non-cemented implants on Paget’s diseased bone performed comparably with non-cemented implants.