Background: Total hip arthroplasty (THA) in patients with Paget’s disease can be associated with technical difculties related to deformities and altered mechanical bone properties, and hypervascularity leads to signifcative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications. Material and methods: Registry-based survival and complication analysis, type of fxation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossifcation [HO]) data were reviewed. Results: In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved signifcantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifcations. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1–6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second postoperative day. Conclusion: THA surgery in Paget’s patients is a safe procedure, and implant survival is only partly afected by bone remodelling and choice of fxation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development.

Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget’s disease: a combined registry and single-institution retrospective observational study / Di Martino, Alberto; Coppola, Maria Antonietta Rita; Bordini, Barbara; Stefanini, Niccolò; Geraci, Giuseppe; Pilla, Federico; Traina, Francesco; Faldini, Cesare. - In: JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY. - ISSN 1590-9921. - ELETTRONICO. - 22:1(2021), pp. 13.1-13.10. [10.1186/s10195-021-00574-y]

Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget’s disease: a combined registry and single-institution retrospective observational study

Di Martino, Alberto
Primo
;
Stefanini, Niccolò;Geraci, Giuseppe;Pilla, Federico;Traina, Francesco;Faldini, Cesare
Ultimo
2021

Abstract

Background: Total hip arthroplasty (THA) in patients with Paget’s disease can be associated with technical difculties related to deformities and altered mechanical bone properties, and hypervascularity leads to signifcative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications. Material and methods: Registry-based survival and complication analysis, type of fxation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossifcation [HO]) data were reviewed. Results: In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved signifcantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifcations. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1–6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second postoperative day. Conclusion: THA surgery in Paget’s patients is a safe procedure, and implant survival is only partly afected by bone remodelling and choice of fxation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development.
2021
Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget’s disease: a combined registry and single-institution retrospective observational study / Di Martino, Alberto; Coppola, Maria Antonietta Rita; Bordini, Barbara; Stefanini, Niccolò; Geraci, Giuseppe; Pilla, Federico; Traina, Francesco; Faldini, Cesare. - In: JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY. - ISSN 1590-9921. - ELETTRONICO. - 22:1(2021), pp. 13.1-13.10. [10.1186/s10195-021-00574-y]
Di Martino, Alberto; Coppola, Maria Antonietta Rita; Bordini, Barbara; Stefanini, Niccolò; Geraci, Giuseppe; Pilla, Federico; Traina, Francesco; Faldini, Cesare
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/815836
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