Hip arthroplasty in patients with Paget's disease

In individuals with Paget's disease, the pelvis and upper femur are the areas of the skeleton most frequently involved. Associated deformities and alterations in bone quality can complicate total hip arthroplasty when required for degenerative joint changes, and can compromise outcome. A review of reported series shows that patients with Paget's disease may present unique problems during the preoperative assessment, intraoperative treatment, and postoperative followup. Preoperative determination of disease activity and assessment of the cause of hip symptoms is important. Intraoperatively, deformity such as coxa vara, femoral bowing, acetabular protrusio, and bony enlargement may cause alterations in implant choice or fixation method used and the patient may even require corrective osteotomy. Excessive bleeding and bone quality changes may complicate these efforts additionally. Postoperative problems include heterotopic bone formation, and in those patients in whom the underlying disease is highly active or poorly controlled, rapid postoperative bone resorption is possible. Results of cemented arthroplasty in patients with Paget's disease have been reported as comparable with but slightly worse than the results reported for unselected patients who underwent hip arthroplasty. The long-term results of uncemented implants in patients with Paget's disease remains to be established.