Outcome of uncemented hip arthroplasty components in patients with Paget's disease

The outcome of uncemented hip arthroplasty in patients with Paget's disease is unknown. The clinical and radiographic records of patients with Paget's disease affecting the hip who had total hip arthroplasty using uncemented components against pagetic bone were reviewed. There were 18 patients (19 hips) with an average age of 71.3 years (range, 54-85 years). Followup averaged 7 years (range, 2-15 years). Surgery often was reported to be demanding technically because of hard sclerotic bone and excessive bleeding in some patients. Estimated blood loss averaged 996 mL (range, 200-2500 mL). Harris hip scores improved significantly. There was clinical and radiographic evidence of bone ingrowth in all patients. Six of 19 hips had heterotopic bone. One hip had severe Brooker Grade IV heterotopic ossification and the patient required excision of the ossification at 5 years. One hip was unstable (subluxating) at the latest followup. There was no revision for component loosening and no recognized cases of clinical or radiographic loosening of any uncemented implants. Results of total hip arthroplasty using uncemented components in patients with Paget's disease are excellent overall, with an extremely low risk of component loosening during the first decade after implantation. These patients may be at higher risk for heterotopic bone formation and increased perioperative blood loss because of hypervascularity of the bone.