Download PDF
CC BY-NC-ND 4.0 · Joints 2019; 07(04): 222-227
DOI: 10.1055/s-0041-1730381
Case Report

Bilateral Cemented Custom-Made Total Hip Arthroplasty in Paget's Disease with Femoral Cortical Thickening and Canal Narrowing

Riccardo D'Ambrosi 
1   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
,
Luca Ballini
1   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
2   Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
,
Federico Valli
1   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
,
Stefano Guarino
1   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
,
Maurizio Rubino
1   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
,
Nicola Ursino
1   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

In this report, we present a case of a 57-year-old man complaining of pain in both his hips. Clinically, the patient reported lameness and reduction in the range of motion of the hips. Radiographic imaging showed a very narrow medullary femoral canal, confirmed by a computed tomography scan. In consideration of the narrowness of the femoral canal and cortex thickening, and due to the rarity of the clinical case, we opted to use a custom-made prosthesis. We performed total hip arthroplasty, initially on the right side. One year later, we repeated the procedure on the left side. One year after the last surgery, the patient reported well-being and continuous improvement in walking, with no complications. This case report highlights the features and the critical issues related to this kind of surgery in patients affected by Paget's disease of the bone and the importance of custom-made implants in challenging cases.

Keywords

Paget's disease - rare disease - custom-made hip arthroplasty - femoral cortical thickening - canal narrowing


Publication History

Received: 27 November 2019

Accepted: 19 April 2021

Article published online:
14 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Coppes-Zantinga AR, Coppes MJ. Sir James Paget (1814-1889): a great academic Victorian. J Am Coll Surg 2000; 191 (01) 70-74
    CrossrefPubMedGoogle Scholar
  • 2 Paget J. On a form of chronic inflammation of bones (osteitis deformans). Med Chir Trans 1877; 60: 37-64 , 9
    CrossrefPubMedGoogle Scholar
  • 3 van Staa TP, Selby P, Leufkens HG, Lyles K, Sprafka JM, Cooper C. Incidence and natural history of Paget's disease of bone in England and Wales. J Bone Miner Res 2002; 17 (03) 465-471
    CrossrefPubMedGoogle Scholar
  • 4 Ralston SH, Corral-Gudino L, Cooper C. et al. Clinical guidelines on Paget's disease of bone. J Bone Miner Res 2019; 34 (12) 2327-2329
    CrossrefPubMedGoogle Scholar
  • 5 Al Nofal AA, Altayar O, BenKhadra K. et al. Bone turnover markers in Paget's disease of the bone: a systematic review and meta-analysis. Osteoporos Int 2015; 26 (07) 1875-1891
    CrossrefPubMedGoogle Scholar
  • 6 Roodman GD, Windle JJ. Paget disease of bone. J Clin Invest 2005; 115 (02) 200-208
    CrossrefPubMedGoogle Scholar
  • 7 Cundy T. Paget's disease of bone. Metabolism 2018; 80: 5-14
    CrossrefPubMedGoogle Scholar
  • 8 Al-Rashid M, Ramkumar DB, Raskin K, Schwab J, Hornicek FJ, Lozano-Calderón SA. Paget disease of bone. Orthop Clin North Am 2015; 46 (04) 577-585
    CrossrefPubMedGoogle Scholar
  • 9 Lee GC, Sanchez-Sotelo J, Berry DJ. Total knee arthroplasty in patients with Paget's disease of bone at the knee. J Arthroplasty 2005; 20 (06) 689-693
    CrossrefPubMedGoogle Scholar
  • 10 Tyagi V, Lajam C, Deshmukh AJ. Total hip arthroplasty in Paget's disease a review. Bull Hosp Jt Dis (2013) 2016; 74 (04) 270-274
    PubMedGoogle Scholar
  • 11 Merlotti D, Gennari L, Martini G, Nuti R. Current options for the treatment of Paget's disease of the bone. Open Access Rheumatol 2009; 1: 107-120
    CrossrefPubMedGoogle Scholar
  • 12 Makaram N, Woods L, Beattie N, Roberts SB, Macpherson GJ. Long-term outcomes following total hip and total knee arthroplasty in patients with Paget's disease of bone (PDB) - a national study. Surgeon 2020; 18 (06) 335-343
    CrossrefPubMedGoogle Scholar
  • 13 Hurley TE, Cashman J, Synnott KA, O'Byrne JM, Lyons FG. Cemented versus cementless total hip arthroplasty in Paget's disease of bone: a systematic review. J Hip Surg 2017; 1: 87-92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Hanna SA, Dawson-Bowling S, Millington S, Bhumbra R, Achan P. Total hip arthroplasty in patients with Paget's disease of bone: a systematic review. World J Orthop 2017; 8 (04) 357-363
    CrossrefPubMedGoogle Scholar
  • 15 Moya-Angeler J, Zambrana L, Westrich GH, Lane JM. Atypical femoral fracture post total hip replacement in a patient with hip osteoarthritis and an ipsilateral cortical thickening. Hip Int 2016; 26 (02) e19-e23
    CrossrefPubMedGoogle Scholar
  • 16 Tsiampas DT, Pakos EE, Georgiadis GC, Xenakis TA. Custom-made femoral implants in total hip arthroplasty due to congenital disease of the hip: a review. Hip Int 2016; 26 (03) 209-214
    CrossrefPubMedGoogle Scholar
  • 17 Bargar WL. Shape the implant to the patient. A rationale for the use of custom-fit cementless total hip implants. Clin Orthop Relat Res 1989; (249) 73-78
    PubMedGoogle Scholar
  • 18 Aamodt A, Lund-Larsen J, Eine J, Andersen E, Benum P, Husby OS. Changes in proximal femoral strain after insertion of uncemented standard and customised femoral stems. An experimental study in human femora. J Bone Joint Surg Br 2001; 83 (06) 921-929
    CrossrefPubMedGoogle Scholar
  • 19 Helm CS, Greenwald AS. The rationale and performance of modularity in total hip arthroplasty. Orthopedics 2005; 28 (9, Suppl): s1113-s1115
    PubMedGoogle Scholar
  • 20 Jasty M, O'Connor DO, Henshaw RM, Harrigan TP, Harris WH. Fit of the uncemented femoral component and the use of cement influence the strain transfer the femoral cortex. J Orthop Res 1994; 12 (05) 648-656
    CrossrefPubMedGoogle Scholar
  • 21 Sedlacek RC, O'Connor DO, Lozynsky AJ, Harris WH. Assessment of the symmetry of bone strains in the proximal femoral medial cortex under load in bilateral pairs of cadaver femurs. J Arthroplasty 1997; 12 (06) 689-694
    CrossrefPubMedGoogle Scholar
  • 22 Kobayashi S, Terayama K. Factors influencing survivorship of the femoral component after primary low-friction hip arthroplasty. J Arthroplasty 1992; 7 (Suppl): 327-338
    CrossrefPubMedGoogle Scholar
  • 23 Menéndez-Bueyes LR, Soler Fernández MD. Paget's disease of bone: approach to its historical origins. Reumatol Clin 2017; 13 (02) 66-72
    CrossrefPubMedGoogle Scholar
  • 24 Muschitz C, Feichtinger X, Haschka J, Kocijan R. Diagnosis and treatment of Paget's disease of bone : a clinical practice guideline. Wien Med Wochenschr 2017; 167 (1-2): 18-24
    CrossrefPubMedGoogle Scholar
  • 25 Lusty PJ, Walter WL, Walter WK, Zicat B. Cementless hip arthroplasty in Paget's disease at medium-term follow-up (average of 6.7 years). J Arthroplasty 2007; 22 (05) 692-696
    CrossrefPubMedGoogle Scholar
  • 26 Crego-Vita D, Aedo-Martín D, Sánchez-Pérez C. Case report of early aseptic loosening of total hip arthroplasty in monostotic Paget disease, a diagnostic challenge. Int J Surg Case Rep 2016; 24: 215-218
    CrossrefPubMedGoogle Scholar
  • 27 Silverman S, Kupperman E, Bukata S. Bisphosphonate-related atypical femoral fracture: managing a rare but serious complication. Cleve Clin J Med 2018; 85 (11) 885-893
    CrossrefPubMedGoogle Scholar