Primary and revision total hip arthroplasty with uncemented acetabular components in patients with Paget's disease.

Abstract

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. 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. 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. 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.