RECONSTRUCTION NAILING AND SERIAL CORTICOTOMY FOR PAGETS-DISEASE OF THE FEMUR

Paget's disease of the femur causes symptoms due to bone pain and defo rmity, stress fractures which may extend to full fracture, and arthrit is of the hip or knee. Standard internal fixation and arthroplasty tec hniques may prove inadequate due to abnormal bone quality and derangem ent of the load-bearing axis. We have addressed this problem with a ra dical technique involving medical treatment and surgical realignment a nd stabilization of the femur. Patients are pretreated with diphosphon ates to normalize born turnover and vascularity. Reconstruction nailin g is then performed with serial corticotomies to realign the mechanica l axis. The first corticotomy is subtrochanteric, allowing a valgus os teotomy of the hip to correct coxa vara. We have performed this proced ure in four cases without complications. Patients have mobilized promp tly and all corticotomies and stress fractures have united rapidly. If arthritic symptoms persist, total hip or knee arthroplasty are standa rd procedures, preceded by nail removal from the united, realigned fem ur.