Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2017; 8(4): 357-363
Published online Apr 18, 2017. doi: 10.5312/wjo.v8.i4.357
Total hip arthroplasty in patients with Paget’s disease of bone: A systematic review
Sammy A Hanna, Sebastian Dawson-Bowling, Steven Millington, Rej Bhumbra, Pramod Achan
Sammy 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
Author contributions: Hanna SA and Dawson-Bowling S designed the research; Hanna SA and Dawson-Bowling S performed the research; Hanna SA, Dawson-Bowling S and Millington S analyzed the data; Hanna SA and Millington S wrote the paper; Bhumbra R and Achan P supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at sammy.hanna@bartshealth.nhs.uk.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sammy A Hanna, MD (Res), FRCS (Tr and Orth), Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom. sammy.hanna@bartshealth.nhs.uk
Telephone: +44-0207-3777000 Fax: +44-0207-37770010
Received: November 21, 2016
Peer-review started: November 23, 2016
First decision: December 15, 2016
Revised: December 21, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: April 18, 2017
Abstract
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.

Keywords: Total hip arthroplasty, Paget’s disease, Revision, Loosening, Heterotopic ossification

Core tip: Patients with Paget’s disease commonly develop structural bone deformities in the proximal femur, making total hip arthroplasty (THA) technically demanding. In addition, achieving adequate fixation of hip implants in the hypervascular and often sclerotic bone may prove challenging. This review has shown that, despite its challenging nature, THA can be very successful in terms of improving symptoms and restoring hip function in this unique group of patients. The failure rate, however, appears to be slightly higher than in other patients undergoing a primary total hip replacement. The most common reason for revision surgery is aseptic loosening, and using modern uncemented implants appear to reduce the risk of this occurring.