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Primary and revision total hip arthroplasty with uncemented acetabular components in patients with Paget's disease
Meagan E Tibbo1, Timothy S Brown2, Arlen D Hanssen1
1Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
Insights
Total hip arthroplasty (THA) in Paget's disease shows good implant survivorship with uncemented components. However, bleeding and heterotopic ossification (HO) remain concerns for patients undergoing hip replacement surgery.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Paget's Disease of Bone
Background:
- Paget's disease affects 3-4% of the population.
- Limited literature exists on total hip arthroplasty (THA) outcomes in Paget's disease patients.
- Concerns include bleeding, heterotopic ossification (HO), and component loosening.
Purpose of the Study:
- To evaluate implant survivorship, radiographic results, and clinical outcomes of primary and revision THAs in patients with Paget's disease.
- To assess the efficacy of contemporary uncemented acetabular components in this population.
Main Methods:
- Retrospective review of 25 THAs in Paget's disease patients from 1999-2014.
- Utilized contemporary uncemented acetabular components.
- Mean patient age was 78 years, with a mean follow-up of 7 years.
Main Results:
- Primary THA: 100% aseptic acetabular and 94% femoral survivorship at 8 years. 41% received transfusions; 53% developed HO. Mean Harris Hip Score (HHS) improved from 49 to 76.
- Revision THA: 100% survivorship at 5 years. 38% received transfusions; 63% developed HO. Mean HHS improved from 52 to 77.
- No radiographic signs of aseptic loosening in unrevised cases.
Conclusions:
- Contemporary uncemented acetabular components mitigate concerns regarding acetabular fixation in Paget's disease.
- Intraoperative bleeding and heterotopic ossification (HO) remain significant complications.
- THA can achieve good implant survivorship and clinical outcomes in Paget's disease patients.
Introduction:
Paget's disease affects 3-4% of the population; however, literature describing outcomes of total hip arthroplasty (THA) in this population are limited. Given the known concerns with bleeding, heterotopic ossification (HO), and component loosening, we describe our results with primary and revision THAs in Paget's disease with emphasis on implant survivorship, radiographic results, and clinical outcomes.
Methods:
We identified 25 THAs performed with contemporary uncemented acetabular components in patients with Paget's disease from 1999 to 2014. Mean age and follow-up were 78 and 7 years.
Results:
In primary THAs, survivorship free from aseptic acetabular and femoral loosening was 100% and 94% at 8 years. 7 patients (41%) received blood transfusions. HO was seen in 9 (53%). Mean Harris Hip Score (HHS) improved from 49 to 76. In revision THAs, survivorship free from acetabular and/or femoral aseptic loosening was 100% at 5 years. 3 patients (38%) received a transfusion. HO was seen in 5 (63%). Mean HHS improved from 52 to 77. There were no radiographic signs of aseptic loosening among unrevised cases in either group.
Discussion:
Our investigation demonstrates that concerns with acetabular fixation in Paget's disease have been mitigated with contemporary uncemented acetabular components. Complications previously noted, namely intraoperative bleeding and HO, continue to be of concern.
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