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Cementless total hip arthroplasty in Paget's disease of bone: a retrospective review
Julien Wegrzyn1, Vincent Pibarot, Roland Chapurlat
1Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France. julien.wegrzyn@chu-lyon.fr
Insights
Cementless total hip arthroplasty (THA) offers excellent outcomes for Paget's disease of bone (PDB) hip disease. Pre-operative bisphosphonates improve results by reducing disease activity, implant loosening, and blood loss.
Area of Science:
- Orthopedic Surgery
- Bone Metabolism
- Biomaterials
Background:
- Paget's disease of bone (PDB) is a chronic osteopathy causing bone deformities and hip joint issues.
- Total hip arthroplasty (THA) is often necessary for disabling hip disease in PDB patients.
- Uncemented, hydroxyapatite-coated implants are utilized in THA for PDB.
Purpose of the Study:
- To evaluate the management and outcomes of uncemented hydroxyapatite-coated THA in patients with PDB of the hip.
- To assess the impact of disease activity and pre-operative treatment on THA outcomes in PDB.
Main Methods:
- Retrospective study of 39 patients with PDB undergoing uncemented THA.
- Average follow-up of 79.4 months.
- Assessment of functional scores (Harris hip score) and implant status.
Main Results:
- Significant improvement in functional scores, with 84% excellent outcomes.
- No implant revisions required, though one acetabular component showed probable loosening.
- Implant loosening was more frequent in patients with active PDB.
- Pre-operative bisphosphonates reduced disease activity, intra-operative blood loss, and risk of loosening.
Conclusions:
- Cementless THA provides good clinical outcomes for PDB hip disease.
- Controlling PDB activity with pre-operative bisphosphonates is crucial for successful THA.
- Bisphosphonates mitigate risks of implant loosening and excessive blood loss in PDB patients undergoing THA.
Abstract:
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.
