Total hip arthroplasty in patients with Paget's disease of bone: A systematic review
Sammy A Hanna1, Sebastian Dawson-Bowling1, Steven Millington1
1Sammy A Hanna, Sebastian Dawson-Bowling, Steven Millington, Rej Bhumbra, Pramod Achan, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, United Kingdom.
Aim:
To investigate the clinical and functional outcomes following total hip arthroplasty (THA) in patients with Paget's disease.
Methods:
We carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of THA in patients with Paget's disease. Eight studies involving 358 hips were reviewed. The mean age was 70.4 years and follow-up was 8.3 years. There were 247 cemented THAs (69%), 105 uncemented THAs (29%) and 6 hybrid THAs (2%).
Results:
All studies reported significant improvement in hip function following THA. There were 19 cases of aseptic loosening (5%) at a mean of 8.6 years. Three cases occurred in the uncemented cohort (3%) at a mean of 15.3 years and 16 cases developed in the cemented group (6%) at a mean of 7.5 years (P = 0.2052). There were 27 revisions in the 358 cases (8%) occurring at a mean of 7 years. Six revisions occurred in the uncemented cohort (6%) at a mean of 8.6 years and 21 in the cemented cohort (9%) at a mean of 6.5 years (P = 0.5117).
Conclusion:
The findings support the use of THA in patients with Paget's disease hip arthropathy. The post-operative functional outcome is largely similar to other patients; however, the revision rate is higher with aseptic loosening being the most common reason for revision. Uncemented implants appear to be associated with a lower failure rate, however, there were no modern stem designs fixed using current generation cementing techniques used in the reported studies, and as such, caution is advised when drawing any conclusions.
