Hip arthroplasty in patients with Paget's disease

In individuals with Paget's disease, the pelvis and upper femur are the are as of the skeleton most frequently involved. Associated deformities and alt erations in bone quality can complicate total hip arthroplasty when require d for degenerative joint changes, and can compromise outcome. A review of r eported series shows that patients with Paget's disease may present unique problems during the preoperative assessment, intraoperative treatment, and postoperative followup. Preoperative determination of disease activity and assessment of the cause of hip symptoms is important. Intraoperatively, def ormity such as coxa vara, femoral bowing, acetabular protrusio, and bony en largement may cause alterations in implant choice or fixation method used a nd the patient may even require corrective osteotomy. Excessive bleeding an d bone quality changes may complicate these efforts additionally. Postopera tive problems include heterotopic bone formation, and in those patients in whom the underlying disease is highly active or poorly controlled, rapid po stoperative bone resorption is possible. Results of cemented arthroplasty i n patients with Paget's disease have been reported as comparable with but s lightly worse than the results reported for unselected patients who underwe nt hip arthroplasty. The long-term results of uncemented implants in patien ts with Paget's disease remains to be established.